Provider Demographics
NPI:1013499714
Name:RUEDA, MARILYN (CAC)
Entity Type:Individual
Prefix:MRS
First Name:MARILYN
Middle Name:
Last Name:RUEDA
Suffix:
Gender:F
Credentials:CAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:P.O. BOX 112501
Mailing Address - Street 2:
Mailing Address - City:HIALEAH
Mailing Address - State:FL
Mailing Address - Zip Code:33010
Mailing Address - Country:US
Mailing Address - Phone:305-332-1976
Mailing Address - Fax:
Practice Address - Street 1:310 E 5TH ST.
Practice Address - Street 2:
Practice Address - City:HIALEAH
Practice Address - State:FL
Practice Address - Zip Code:33010
Practice Address - Country:US
Practice Address - Phone:305-332-1976
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-08-30
Last Update Date:2018-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCAC100165324500000X, 3245S0500X, 374K00000X, 101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No324500000XResidential Treatment FacilitiesSubstance Abuse Rehabilitation Facility
No3245S0500XResidential Treatment FacilitiesSubstance Abuse Rehabilitation FacilitySubstance Abuse Treatment, Children
No374K00000XNursing Service Related ProvidersReligious Nonmedical Practitioner