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General NPI Number Information
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NPI Number | 1013499714
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Entity Type | Individual
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Provider Name | MARILYN RUEDA CAC
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Gender | Female
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Dates
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Enumeration Date | 08/30/2018
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Last Update Date | 08/30/2018
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Provider Practice Location Address
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Address Line | 310 E 5TH ST.
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City | HIALEAH
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State | FL
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Zip | 33010
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Country | US
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Telephone | 305-332-1976
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Fax |
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Provider Business Mailing Address
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Address Line | P.O. BOX 112501
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City | HIALEAH
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State | FL
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Zip | 33010
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Country | US
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Telephone | 305-332-1976
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 324500000X
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Taxonomy Name | Substance Abuse Rehabilitation Facility
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License Number | CAC100165
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License Number State | FL
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Taxonomy #2
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Taxonomy Code | 3245S0500X
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Taxonomy Name | Children's Substance Abuse Rehabilitation Facility
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License Number | CAC100165
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License Number State | FL
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Taxonomy #3
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Taxonomy Code | 374K00000X
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Taxonomy Name | Religious Nonmedical Practitioner
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License Number | CAC100165
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License Number State | FL
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Taxonomy #4
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Taxonomy Code | 101YA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Counselor
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License Number | CAC100165
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License Number State | FL
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