Provider Demographics
NPI:1205256690
Name:RANDI RUELA
Entity type:Organization
Organization Name:RANDI RUELA
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER, ACUPUNCTURIST, CHIROPRACTOR
Authorized Official - Prefix:
Authorized Official - First Name:RANDI
Authorized Official - Middle Name:LYNN
Authorized Official - Last Name:RUELA
Authorized Official - Suffix:
Authorized Official - Credentials:DC, LAC
Authorized Official - Phone:951-428-4135
Mailing Address - Street 1:710 RIMPAU AVE STE 106
Mailing Address - Street 2:
Mailing Address - City:CORONA
Mailing Address - State:CA
Mailing Address - Zip Code:92879-5724
Mailing Address - Country:US
Mailing Address - Phone:951-428-4135
Mailing Address - Fax:951-339-3623
Practice Address - Street 1:710 RIMPAU AVE STE 106
Practice Address - Street 2:
Practice Address - City:CORONA
Practice Address - State:CA
Practice Address - Zip Code:92879-5724
Practice Address - Country:US
Practice Address - Phone:951-428-4135
Practice Address - Fax:951-339-3623
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:INNER QI WELLNESS INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2014-04-24
Last Update Date:2021-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA15916171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171100000XOther Service ProvidersAcupuncturistGroup - Single Specialty