Provider Demographics
NPI:1013177906
Name:FAELDONEA-SERUELO, RHYL ANN FENEQUITO (MD)
Entity Type:Individual
Prefix:
First Name:RHYL ANN
Middle Name:FENEQUITO
Last Name:FAELDONEA-SERUELO
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:RHYL ANN
Other - Middle Name:FAELDONEA
Other - Last Name:SERUELO
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:332 S JUNIPER ST STE 100
Mailing Address - Street 2:
Mailing Address - City:ESCONDIDO
Mailing Address - State:CA
Mailing Address - Zip Code:92025-4941
Mailing Address - Country:US
Mailing Address - Phone:866-228-2236
Mailing Address - Fax:760-738-9047
Practice Address - Street 1:225 E 2ND AVE
Practice Address - Street 2:STE. 101
Practice Address - City:ESCONDIDO
Practice Address - State:CA
Practice Address - Zip Code:92025-4212
Practice Address - Country:US
Practice Address - Phone:760-291-6700
Practice Address - Fax:760-738-9047
Is Sole Proprietor?:No
Enumeration Date:2008-06-13
Last Update Date:2020-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA104676207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CABT692Medicare PIN