Provider Demographics
NPI:1760057939
Name:RUELAS, YESICA G (CMT)
Entity Type:Individual
Prefix:
First Name:YESICA
Middle Name:G
Last Name:RUELAS
Suffix:
Gender:F
Credentials:CMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11550 ROSECRANS AVE STE 106
Mailing Address - Street 2:
Mailing Address - City:NORWALK
Mailing Address - State:CA
Mailing Address - Zip Code:90650-3881
Mailing Address - Country:US
Mailing Address - Phone:562-293-3336
Mailing Address - Fax:562-735-0205
Practice Address - Street 1:11550 ROSECRANS AVE STE 106
Practice Address - Street 2:
Practice Address - City:NORWALK
Practice Address - State:CA
Practice Address - Zip Code:90650-3881
Practice Address - Country:US
Practice Address - Phone:562-474-1314
Practice Address - Fax:562-735-0205
Is Sole Proprietor?:Yes
Enumeration Date:2021-05-20
Last Update Date:2021-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA82191225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage TherapistGroup - Single Specialty