Provider Demographics
NPI:1922576446
Name:RUEDA, JIMENA E
Entity Type:Individual
Prefix:
First Name:JIMENA
Middle Name:E
Last Name:RUEDA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:46103 INGOMAR TER
Mailing Address - Street 2:
Mailing Address - City:STERLING
Mailing Address - State:VA
Mailing Address - Zip Code:20166-4262
Mailing Address - Country:US
Mailing Address - Phone:157-131-5941
Mailing Address - Fax:
Practice Address - Street 1:46103 INGOMAR TER
Practice Address - Street 2:
Practice Address - City:STERLING
Practice Address - State:VA
Practice Address - Zip Code:20166-4262
Practice Address - Country:US
Practice Address - Phone:157-131-5941
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-11-02
Last Update Date:2018-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician