Healthcare Provider Details

I. General information

NPI: 1275857997
Provider Name (Legal Business Name): MELISA A RUELAS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/24/2010
Last Update Date: 08/20/2026
Certification Date: 08/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

202 FASHION LN STE 215
TUSTIN CA
92780-3320
US

IV. Provider business mailing address

10942 HARROGATE PL
SANTA ANA CA
92705-2353
US

V. Phone/Fax

Practice location:
  • Phone: 949-734-0604
  • Fax: 951-266-6060
Mailing address:
  • Phone: 949-734-0604
  • Fax: 951-266-6060

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number83290
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: