Provider Demographics
NPI:1053483578
Name:RUEDA-MATIK, LIBIA (MD)
Entity Type:Individual
Prefix:
First Name:LIBIA
Middle Name:
Last Name:RUEDA-MATIK
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:148 EAST AVENUE
Mailing Address - Street 2:SUITE #1L
Mailing Address - City:NORWALK
Mailing Address - State:CT
Mailing Address - Zip Code:06851
Mailing Address - Country:US
Mailing Address - Phone:203-854-6993
Mailing Address - Fax:203-854-9227
Practice Address - Street 1:148 EAST AVENUE
Practice Address - Street 2:SUITE #1L
Practice Address - City:NORWALK
Practice Address - State:CT
Practice Address - Zip Code:06851
Practice Address - Country:US
Practice Address - Phone:203-854-6993
Practice Address - Fax:203-854-9227
Is Sole Proprietor?:No
Enumeration Date:2006-11-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT038173208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics