Provider Demographics
NPI:1093225609
Name:RUA, JOSE ALEXANDER (MA, CAP, ICADC)
Entity Type:Individual
Prefix:
First Name:JOSE
Middle Name:ALEXANDER
Last Name:RUA
Suffix:
Gender:M
Credentials:MA, CAP, ICADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2331 NE 37TH TER
Mailing Address - Street 2:
Mailing Address - City:HOMESTEAD
Mailing Address - State:FL
Mailing Address - Zip Code:33033-5146
Mailing Address - Country:US
Mailing Address - Phone:305-785-7931
Mailing Address - Fax:
Practice Address - Street 1:2331 NE 37TH TER
Practice Address - Street 2:
Practice Address - City:HOMESTEAD
Practice Address - State:FL
Practice Address - Zip Code:33033-5146
Practice Address - Country:US
Practice Address - Phone:305-785-7931
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-10-09
Last Update Date:2017-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL1468101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)