Provider Demographics
NPI:1932324316
Name:RUOTOLO, FEDERICO D
Entity Type:Individual
Prefix:
First Name:FEDERICO
Middle Name:D
Last Name:RUOTOLO
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3035 PRATHER LN
Mailing Address - Street 2:
Mailing Address - City:SANTA CRUZ
Mailing Address - State:CA
Mailing Address - Zip Code:95065-1801
Mailing Address - Country:US
Mailing Address - Phone:831-476-4184
Mailing Address - Fax:
Practice Address - Street 1:3035 PRATHER LN
Practice Address - Street 2:3035 PRATHER LANE
Practice Address - City:SANTA CRUZ
Practice Address - State:CA
Practice Address - Zip Code:95065-1801
Practice Address - Country:US
Practice Address - Phone:831-476-4184
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-04-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health