Provider Demographics
NPI:1295536019
Name:RUCKER, CHE TIMOTHY
Entity type:Individual
Prefix:
First Name:CHE
Middle Name:TIMOTHY
Last Name:RUCKER
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1000 S FREMONT AVE UNIT 20
Mailing Address - Street 2:
Mailing Address - City:ALHAMBRA
Mailing Address - State:CA
Mailing Address - Zip Code:91803-8840
Mailing Address - Country:US
Mailing Address - Phone:626-349-3838
Mailing Address - Fax:855-838-9042
Practice Address - Street 1:1000 S FREMONT AVE UNIT 20
Practice Address - Street 2:
Practice Address - City:ALHAMBRA
Practice Address - State:CA
Practice Address - Zip Code:91803-8840
Practice Address - Country:US
Practice Address - Phone:626-349-3838
Practice Address - Fax:855-838-9042
Is Sole Proprietor?:No
Enumeration Date:2025-03-19
Last Update Date:2025-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician