Provider Demographics
NPI:1598103632
Name:RUEDA, IVONNE (L AC)
Entity Type:Individual
Prefix:MRS
First Name:IVONNE
Middle Name:
Last Name:RUEDA
Suffix:
Gender:F
Credentials:L AC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1530 SANTA SIERRA DR
Mailing Address - Street 2:
Mailing Address - City:CHULA VISTA
Mailing Address - State:CA
Mailing Address - Zip Code:91913-2869
Mailing Address - Country:US
Mailing Address - Phone:619-454-1898
Mailing Address - Fax:
Practice Address - Street 1:1530 SANTA SIERRA DR
Practice Address - Street 2:
Practice Address - City:CHULA VISTA
Practice Address - State:CA
Practice Address - Zip Code:91913-2869
Practice Address - Country:US
Practice Address - Phone:619-454-1898
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-06-11
Last Update Date:2013-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAC 15280171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist