Provider Demographics
NPI:1821072174
Name:RUELAZ MAHER, ALICIA RENAE (MD)
Entity Type:Individual
Prefix:DR
First Name:ALICIA
Middle Name:RENAE
Last Name:RUELAZ MAHER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:ALICIA
Other - Middle Name:
Other - Last Name:RUELAZ
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:530 WILSHIRE BLVD STE 306
Mailing Address - Street 2:
Mailing Address - City:SANTA MONICA
Mailing Address - State:CA
Mailing Address - Zip Code:90401-1426
Mailing Address - Country:US
Mailing Address - Phone:310-692-9517
Mailing Address - Fax:424-298-4153
Practice Address - Street 1:530 WILSHIRE BLVD STE 306
Practice Address - Street 2:
Practice Address - City:SANTA MONICA
Practice Address - State:CA
Practice Address - Zip Code:90401-1426
Practice Address - Country:US
Practice Address - Phone:310-692-9517
Practice Address - Fax:310-692-9517
Is Sole Proprietor?:No
Enumeration Date:2005-11-30
Last Update Date:2020-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA776922084P0800X, 174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
No2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAI06617Medicare UPIN