Provider Demographics
NPI:1043661622
Name:REY RUEDA, JUAN ESTEBAN (MD)
Entity Type:Individual
Prefix:
First Name:JUAN
Middle Name:ESTEBAN
Last Name:REY RUEDA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3540 W SAHARA AVE # 330
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89102-5816
Mailing Address - Country:US
Mailing Address - Phone:725-217-8555
Mailing Address - Fax:702-259-1252
Practice Address - Street 1:3540 W SAHARA AVE # 330
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89102-5816
Practice Address - Country:US
Practice Address - Phone:725-217-8555
Practice Address - Fax:702-259-1252
Is Sole Proprietor?:Yes
Enumeration Date:2016-06-25
Last Update Date:2020-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV19249208M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208M00000XAllopathic & Osteopathic PhysiciansHospitalistGroup - Single Specialty