Provider Demographics
NPI:1386830164
Name:RUELAS, DALENNA MARIE
Entity Type:Individual
Prefix:
First Name:DALENNA
Middle Name:MARIE
Last Name:RUELAS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3770 FLORA VISTA AVE APT 604
Mailing Address - Street 2:
Mailing Address - City:SANTA CLARA
Mailing Address - State:CA
Mailing Address - Zip Code:95051-4352
Mailing Address - Country:US
Mailing Address - Phone:510-759-1432
Mailing Address - Fax:
Practice Address - Street 1:222 PAUL SCANNELL DR
Practice Address - Street 2:
Practice Address - City:SAN MATEO
Practice Address - State:CA
Practice Address - Zip Code:94402-4061
Practice Address - Country:US
Practice Address - Phone:650-312-5322
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-09-14
Last Update Date:2007-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health