Healthcare Provider Details

I. General information

NPI: 1720274723
Provider Name (Legal Business Name): CINDY RUELAS-TAFOLLA D.S.W
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/24/2007
Last Update Date: 06/03/2021
Certification Date: 06/03/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

600 W CAMPBELL RD STE 1
RICHARDSON TX
75080-3357
US

IV. Provider business mailing address

4261 E UNIVERSITY DR # 30-135
PROSPER TX
75078-9152
US

V. Phone/Fax

Practice location:
  • Phone: 847-903-5604
  • Fax: 224-788-5112
Mailing address:
  • Phone: 469-237-8980
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number4220530
License Number StateTX
# 2
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number56468
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: