Provider Demographics
NPI:1720522089
Name:RUELAS, CAROLYN
Entity Type:Individual
Prefix:
First Name:CAROLYN
Middle Name:
Last Name:RUELAS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:751 RANCHEROS DR
Mailing Address - Street 2:SUITE 5
Mailing Address - City:SAN MARCOS
Mailing Address - State:CA
Mailing Address - Zip Code:92069-3041
Mailing Address - Country:US
Mailing Address - Phone:760-761-0515
Mailing Address - Fax:760-761-0464
Practice Address - Street 1:1400 N JOHNSON AVE
Practice Address - Street 2:SUITE 101
Practice Address - City:EL CAJON
Practice Address - State:CA
Practice Address - Zip Code:92020-1650
Practice Address - Country:US
Practice Address - Phone:619-442-0277
Practice Address - Fax:619-442-1101
Is Sole Proprietor?:Yes
Enumeration Date:2016-12-06
Last Update Date:2016-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)