Provider Demographics
NPI:1740800127
Name:ALAVANZA, RUEL REY O (RN, RT)
Entity Type:Individual
Prefix:
First Name:RUEL REY
Middle Name:O
Last Name:ALAVANZA
Suffix:
Gender:M
Credentials:RN, RT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1438 S MT VIEW AVE
Mailing Address - Street 2:
Mailing Address - City:SAN BERNARDINO
Mailing Address - State:CA
Mailing Address - Zip Code:92408-3132
Mailing Address - Country:US
Mailing Address - Phone:909-536-9169
Mailing Address - Fax:
Practice Address - Street 1:11606 ANDERSON ST
Practice Address - Street 2:
Practice Address - City:LOMA LINDA
Practice Address - State:CA
Practice Address - Zip Code:92354-3457
Practice Address - Country:US
Practice Address - Phone:909-536-9169
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-04-25
Last Update Date:2020-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA793979163WE0003X, 163WH0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WH0200XNursing Service ProvidersRegistered NurseHome Health
No163WE0003XNursing Service ProvidersRegistered NurseEmergency