Provider Demographics
NPI:1720274723
Name:RUELAS-TAFOLLA, CINDY (DSW)
Entity Type:Individual
Prefix:DR
First Name:CINDY
Middle Name:
Last Name:RUELAS-TAFOLLA
Suffix:
Gender:F
Credentials:DSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4261 E UNIVERSITY DR # 30-135
Mailing Address - Street 2:
Mailing Address - City:PROSPER
Mailing Address - State:TX
Mailing Address - Zip Code:75078-9152
Mailing Address - Country:US
Mailing Address - Phone:469-237-8980
Mailing Address - Fax:
Practice Address - Street 1:600 W CAMPBELL RD STE 1
Practice Address - Street 2:
Practice Address - City:RICHARDSON
Practice Address - State:TX
Practice Address - Zip Code:75080-3357
Practice Address - Country:US
Practice Address - Phone:847-903-5604
Practice Address - Fax:224-788-5112
Is Sole Proprietor?:Yes
Enumeration Date:2007-09-24
Last Update Date:2021-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX4220530171M00000X
TX564681041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No171M00000XOther Service ProvidersCase Manager/Care Coordinator
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA19302OtherACSW