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NPI Code Detail

MEDICARE: JUSEL MARIE RUELAN D.O.

MEDICARE: JUSEL MARIE RUELAN D.O.
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1207QA0000XAdolescent Medicine (Family Medicine) Physician20A13811CA
2207QG0300XGeriatric Medicine (Family Medicine) Physician20A13811CA
3207QA0505XAdult Medicine Physician20A13811CA

General Provider Information

NPI Number : 1942644398
Entity Type Code : Individual
Provider Name (Legal Business Name) : JUSEL MARIE RUELAN D.O.
Provider Business Mailing Address
First Line : 2625 E DIVISADERO ST
Second Line :
City : FRESNO
State : CA
Zip : 93721-1431
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 290 N WAYTE LN
Second Line :
City : FRESNO
State : CA
Zip : 93701-2124
Country : US
Telephone Number : 559-459-5700
Fax Number : 559-459-6109
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 04/27/2013
Last Update Date : 08/09/2016

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