Basic Information
| Provider Information | |||||||||
| NPI: | 1811558794 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | RUELAS | ||||||||
| FirstName: | IRIS | ||||||||
| MiddleName: | MARISOL | ||||||||
| NamePrefix: | MRS. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 222 E WORTH ST | ||||||||
| Address2: | |||||||||
| City: | STOCKTON | ||||||||
| State: | CA | ||||||||
| PostalCode: | 952061326 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2092729699 | ||||||||
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| Practice Location | |||||||||
| Address1: | 1947 N CALIFORNIA ST STE B&C | ||||||||
| Address2: | |||||||||
| City: | STOCKTON | ||||||||
| State: | CA | ||||||||
| PostalCode: | 952046029 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2094630870 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 06/22/2019 | ||||||||
| LastUpdateDate: | 06/22/2019 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YA0400X | Y | Behavioral Health & Social Service Providers | Counselor | Addiction (Substance Use Disorder) |
No ID Information.