Provider Demographics
NPI:1952731556
Name:RUELA, RANDI LYNN (DC, LAC)
Entity Type:Individual
Prefix:MRS
First Name:RANDI
Middle Name:LYNN
Last Name:RUELA
Suffix:
Gender:F
Credentials:DC, LAC
Other - Prefix:MS
Other - First Name:RANDI
Other - Middle Name:LYNN
Other - Last Name:HIGINBOTHAM
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
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:
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:
Is Sole Proprietor?:Yes
Enumeration Date:2013-11-18
Last Update Date:2021-05-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAC15916171100000X
CA32763111N00000X
CADC32763111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractor
No171100000XOther Service ProvidersAcupuncturistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1205256690OtherACUPUNCTURE NPI 1
CA1952731556OtherCHIROPRACTIC NPI 1
CA1043758014OtherNPI TYPE 2