Provider Demographics
NPI:1588228308
Name:VALDIVIESO RUEDA, SEBASTIAN CRISTOBAL
Entity Type:Individual
Prefix:
First Name:SEBASTIAN
Middle Name:CRISTOBAL
Last Name:VALDIVIESO RUEDA
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:506 LENOX AVENUE, MLK 11.101
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10037
Mailing Address - Country:US
Mailing Address - Phone:212-939-2976
Mailing Address - Fax:212-939-3536
Practice Address - Street 1:506 LENOX AVENUE, MLK 11.101
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10037
Practice Address - Country:US
Practice Address - Phone:212-939-2976
Practice Address - Fax:212-939-3536
Is Sole Proprietor?:No
Enumeration Date:2019-04-26
Last Update Date:2019-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program