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General NPI Number Information
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NPI Number | 1770724981
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Entity Type | Individual
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Provider Name | BROOKE DIANE RUEHL M.S.
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Gender | Female
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Dates
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Enumeration Date | 03/18/2009
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Last Update Date | 03/18/2009
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Provider Practice Location Address
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Address Line | BLDG. H 2005 KNIGHT LANE NAVY MEDICINE SUPPORT COMMAND, MEDICAL STAFF SERVICES
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City | JACKSONVILLE
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State | FL
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Zip | 32212-0140
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Country | US
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Telephone | 619-532-6460
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Fax |
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Provider Business Mailing Address
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Address Line | 11778 CARMEL CREEK RD C 305
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City | SAN DIEGO
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State | CA
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Zip | 92130-6750
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Country | US
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Telephone | 760-496-8943
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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 | 390200000X
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Taxonomy Name | Student in an Organized Health Care Education/Training Program
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License Number |
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License Number State |
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