Provider Demographics
NPI:1467186759
Name:RUELAS, WENDY
Entity Type:Individual
Prefix:MS
First Name:WENDY
Middle Name:
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 1:45546 BALLATA RD
Mailing Address - Street 2:
Mailing Address - City:NEWBERRY SPRINGS
Mailing Address - State:CA
Mailing Address - Zip Code:92365-9067
Mailing Address - Country:US
Mailing Address - Phone:760-987-9094
Mailing Address - Fax:
Practice Address - Street 1:45546 BALLATA RD
Practice Address - Street 2:
Practice Address - City:NEWBERRY SPRINGS
Practice Address - State:CA
Practice Address - Zip Code:92365-9067
Practice Address - Country:US
Practice Address - Phone:760-987-9094
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-07-12
Last Update Date:2022-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA2255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer