Provider Demographics
NPI:1518537505
Name:PEREDA, RUBY AURORA
Entity Type:Individual
Prefix:
First Name:RUBY
Middle Name:AURORA
Last Name:PEREDA
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 1:120 W HAWTHORNE ST
Mailing Address - Street 2:
Mailing Address - City:FALLBROOK
Mailing Address - State:CA
Mailing Address - Zip Code:92028-2053
Mailing Address - Country:US
Mailing Address - Phone:760-828-2569
Mailing Address - Fax:
Practice Address - Street 1:120 W HAWTHORNE ST
Practice Address - Street 2:
Practice Address - City:FALLBROOK
Practice Address - State:CA
Practice Address - Zip Code:92028-2053
Practice Address - Country:US
Practice Address - Phone:760-731-3235
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-06-30
Last Update Date:2023-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker