Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2080A0000X | Adolescent Medicine | 133654 | NY |
NPI | 1275593543 |
---|---|
Provider Name | Dr. Cecilia P. Ruelos |
First Address | Saratoga Springs, NY 12866-8640 |
Second Address | Saratoga Springs, NY 12866-8640 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 23/03/2006 |
Last Update Date | 16/09/2009 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
00786452 | (05) | NY |
C66682 | (02) | NY |