Provider Demographics
NPI:1033601455
Name:RULLODA, RAQUEL C (NP)
Entity Type:Individual
Prefix:
First Name:RAQUEL
Middle Name:C
Last Name:RULLODA
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4200 CHINO HILLS PKWY STE 135-123
Mailing Address - Street 2:
Mailing Address - City:CHINO HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:91709-3776
Mailing Address - Country:US
Mailing Address - Phone:626-833-9337
Mailing Address - Fax:
Practice Address - Street 1:1900 ROYALTY DR STE 250
Practice Address - Street 2:
Practice Address - City:POMONA
Practice Address - State:CA
Practice Address - Zip Code:91767-3043
Practice Address - Country:US
Practice Address - Phone:909-623-6581
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-06-01
Last Update Date:2018-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAF12170066363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily