Basic Information
| Provider Information | |||||||||
| NPI: | 1306153168 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | RUEDA | ||||||||
| FirstName: | CESAR | ||||||||
| MiddleName: | DAVID | ||||||||
| NamePrefix: | MR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | BCBA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 4660 SW 136TH PL | ||||||||
| Address2: | |||||||||
| City: | MIAMI | ||||||||
| State: | FL | ||||||||
| PostalCode: | 331753717 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7865463755 | ||||||||
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| Practice Location | |||||||||
| Address1: | 7875 NW 12TH ST STE 120 | ||||||||
| Address2: | |||||||||
| City: | DORAL | ||||||||
| State: | FL | ||||||||
| PostalCode: | 331261815 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7865054449 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/31/2010 | ||||||||
| LastUpdateDate: | 10/14/2022 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 10/14/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 103K00000X | Y | Behavioral Health & Social Service Providers | Behavioral Analyst | 103TB0200X | N | Behavioral Health & Social Service Providers | Psychologist | Cognitive & Behavioral |
ID Information
| ID | Type | State | Issuer | Description | 018393500 | 05 | FL | MEDICAID |