Provider Demographics
NPI:1366319196
Name:RUELAS GARCIA, EVELYN (MED)
Entity type:Individual
Prefix:
First Name:EVELYN
Middle Name:
Last Name:RUELAS GARCIA
Suffix:
Gender:F
Credentials:MED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1290 RIDDER PARK DR
Mailing Address - Street 2:
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95131-2304
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:408-453-4231
Practice Address - Street 1:2025 CLARICE DR
Practice Address - Street 2:
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95122-1204
Practice Address - Country:US
Practice Address - Phone:408-270-6751
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-10-17
Last Update Date:2025-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA6CDEA8B619171400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171400000XOther Service ProvidersHealth & Wellness Coach