Provider Demographics
NPI:1427672823
Name:RUEDAS, CRYSTAL MARIE
Entity type:Individual
Prefix:
First Name:CRYSTAL
Middle Name:MARIE
Last Name:RUEDAS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1950 S SUNWEST LN
Mailing Address - Street 2:
Mailing Address - City:SAN BERNARDINO
Mailing Address - State:CA
Mailing Address - Zip Code:92415-3258
Mailing Address - Country:US
Mailing Address - Phone:909-252-4010
Mailing Address - Fax:909-252-4055
Practice Address - Street 1:1950 S SUNWEST LN
Practice Address - Street 2:
Practice Address - City:SAN BERNARDINO
Practice Address - State:CA
Practice Address - Zip Code:92415-3258
Practice Address - Country:US
Practice Address - Phone:909-252-4010
Practice Address - Fax:909-252-4055
Is Sole Proprietor?:Yes
Enumeration Date:2020-06-01
Last Update Date:2020-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program