Basic Information
| Provider Information | |||||||||
| NPI: | 1720349509 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | RUEDA | ||||||||
| FirstName: | KRISTINE | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3730 PLAZA WAY | ||||||||
| Address2: | 5TH FLOOR, TRIOS CARE CENTER SOUTHRIDGE | ||||||||
| City: | KENNEWICK | ||||||||
| State: | WA | ||||||||
| PostalCode: | 99338 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5092215969 | ||||||||
| FaxNumber: | 5095865143 | ||||||||
| Practice Location | |||||||||
| Address1: | 3730 PLAZA WAY | ||||||||
| Address2: | 5TH FLOOR, TRIOS CARE CENTER SOUTHRIDGE | ||||||||
| City: | KENNEWICK | ||||||||
| State: | WA | ||||||||
| PostalCode: | 99338 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5092215969 | ||||||||
| FaxNumber: | 5095865143 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/07/2012 | ||||||||
| LastUpdateDate: | 09/24/2015 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | MD60524138 | WA | Y | Allopathic & Osteopathic Physicians | Family Medicine |
No ID Information.