Provider Demographics
NPI:1720349509
Name:RUEDA, KRISTINE (MD)
Entity Type:Individual
Prefix:
First Name:KRISTINE
Middle Name:
Last Name:RUEDA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3730 PLAZA WAY
Mailing Address - Street 2:5TH FLOOR, TRIOS CARE CENTER SOUTHRIDGE
Mailing Address - City:KENNEWICK
Mailing Address - State:WA
Mailing Address - Zip Code:99338
Mailing Address - Country:US
Mailing Address - Phone:509-221-5969
Mailing Address - Fax:509-586-5143
Practice Address - Street 1:3730 PLAZA WAY
Practice Address - Street 2:5TH FLOOR, TRIOS CARE CENTER SOUTHRIDGE
Practice Address - City:KENNEWICK
Practice Address - State:WA
Practice Address - Zip Code:99338
Practice Address - Country:US
Practice Address - Phone:509-221-5969
Practice Address - Fax:509-586-5143
Is Sole Proprietor?:Yes
Enumeration Date:2012-06-07
Last Update Date:2015-09-24
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
WAMD60524138207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine