Provider Demographics
NPI:1710467113
Name:RUANO, PABLO ABRAHAN (PT, DPT)
Entity Type:Individual
Prefix:
First Name:PABLO
Middle Name:ABRAHAN
Last Name:RUANO
Suffix:
Gender:M
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1901 W LUGONIA AVE STE 120
Mailing Address - Street 2:
Mailing Address - City:REDLANDS
Mailing Address - State:CA
Mailing Address - Zip Code:92374-9704
Mailing Address - Country:US
Mailing Address - Phone:909-557-1600
Mailing Address - Fax:
Practice Address - Street 1:3889 W STETSON AVE STE 100
Practice Address - Street 2:
Practice Address - City:HEMET
Practice Address - State:CA
Practice Address - Zip Code:92545-9682
Practice Address - Country:US
Practice Address - Phone:951-652-1600
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-08-16
Last Update Date:2018-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA295320225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist