Basic Information
| Provider Information | |||||||||
| NPI: | 1043661622 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | REY RUEDA | ||||||||
| FirstName: | JUAN | ||||||||
| MiddleName: | ESTEBAN | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3540 W SAHARA AVE # 330 | ||||||||
| Address2: | |||||||||
| City: | LAS VEGAS | ||||||||
| State: | NV | ||||||||
| PostalCode: | 891025816 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7252178555 | ||||||||
| FaxNumber: | 7022591252 | ||||||||
| Practice Location | |||||||||
| Address1: | 3540 W SAHARA AVE # 330 | ||||||||
| Address2: | |||||||||
| City: | LAS VEGAS | ||||||||
| State: | NV | ||||||||
| PostalCode: | 891025816 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7252178555 | ||||||||
| FaxNumber: | 7022591252 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/25/2016 | ||||||||
| LastUpdateDate: | 06/25/2020 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 06/25/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208M00000X | 19249 | NV | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Hospitalist |
No ID Information.