Basic Information
| Provider Information | |||||||||
| NPI: | 1508594789 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | RUELAS-MORA | ||||||||
| FirstName: | ALEJANDRO | ||||||||
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| Mailing Information | |||||||||
| Address1: | 545 LAUREL ST | ||||||||
| Address2: | |||||||||
| City: | SAN DIEGO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 921011634 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6192334399 | ||||||||
| FaxNumber: | 6192330453 | ||||||||
| Practice Location | |||||||||
| Address1: | 545 LAUREL ST | ||||||||
| Address2: | |||||||||
| City: | SAN DIEGO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 921011634 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6192334399 | ||||||||
| FaxNumber: | 6192330453 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/15/2022 | ||||||||
| LastUpdateDate: | 10/28/2022 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 10/26/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 106S00000X | N | 101YM0800X | Y | Behavioral Health & Social Service Providers | Counselor | Mental Health |
No ID Information.