Healthcare Provider Details

I. General information

NPI: 1053483578
Provider Name (Legal Business Name): LIBIA RUEDA-MATIK MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/14/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

148 EAST AVENUE SUITE #1L
NORWALK CT
06851
US

IV. Provider business mailing address

148 EAST AVENUE SUITE #1L
NORWALK CT
06851
US

V. Phone/Fax

Practice location:
  • Phone: 203-854-6993
  • Fax: 203-854-9227
Mailing address:
  • Phone: 203-854-6993
  • Fax: 203-854-9227

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number038173
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: