Provider Demographics
NPI:1003667734
Name:RUELAS, NOAH CHARLES
Entity Type:Individual
Prefix:
First Name:NOAH
Middle Name:CHARLES
Last Name:RUELAS
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1850 ANTHONY WAY
Mailing Address - Street 2:
Mailing Address - City:YUBA CITY
Mailing Address - State:CA
Mailing Address - Zip Code:95993-5123
Mailing Address - Country:US
Mailing Address - Phone:530-844-7109
Mailing Address - Fax:
Practice Address - Street 1:1526 PLUMAS CT STE 400
Practice Address - Street 2:
Practice Address - City:YUBA CITY
Practice Address - State:CA
Practice Address - Zip Code:95991-2961
Practice Address - Country:US
Practice Address - Phone:530-443-9151
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-03-29
Last Update Date:2024-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA98755703E8Medicaid