Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 104100000X | Social Worker | ||
Y | 1041C0700X | Clinical Social Worker | 85469 | CA |
N | 225400000X | Rehabilitation Practitioner |
NPI | 1003219452 |
---|---|
Provider Name | Mrs. Eliana Ruelas-Perez |
First Address | Van Nuys, CA 91411-1613 |
Second Address | Van Nuys, CA 91411-1613 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 30/09/2014 |
Last Update Date | 13/02/2020 |