Provider Demographics
NPI:1699230235
Name:RUELAS, ERASMO
Entity Type:Individual
Prefix:
First Name:ERASMO
Middle Name:
Last Name:RUELAS
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 1:13082 GOLETA ST
Mailing Address - Street 2:
Mailing Address - City:PACOIMA
Mailing Address - State:CA
Mailing Address - Zip Code:91331-3249
Mailing Address - Country:US
Mailing Address - Phone:818-267-4714
Mailing Address - Fax:
Practice Address - Street 1:13082 GOLETA ST
Practice Address - Street 2:
Practice Address - City:PACOIMA
Practice Address - State:CA
Practice Address - Zip Code:91331-3249
Practice Address - Country:US
Practice Address - Phone:818-267-4714
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-02-07
Last Update Date:2019-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician