Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 103G00000X | Clinical Psychologist | PSY13999 | CA |
N | 103TC0700X | Clinical Psychologist | PSY13999 | CA |
N | 103G00000X | Clinical Psychologist | PSY13999 | CA |
N | 103TC0700X | Clinical Psychologist | PSY13999 | CA |
N | 204D00000X | Neuromusculoskeletal Medicine (NMM) | 20A7737 | CA |
N | 207Q00000X | Family Doctor | 20A7737 | CA |
NPI | 1154461549 |
---|---|
Provider Name | Dr. Gary Ruelas |
First Address | Orange, CA 92866-1620 |
Second Address | Orange, CA 92866-1620 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 07/02/2007 |
Last Update Date | 08/07/2007 |