Provider Demographics
NPI:1528759461
Name:RODRUGUEZ GUEVARA, RUTH EDITH (MD)
Entity type:Individual
Prefix:
First Name:RUTH
Middle Name:EDITH
Last Name:RODRUGUEZ GUEVARA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 120123
Mailing Address - Street 2:
Mailing Address - City:CHULA VISTA
Mailing Address - State:CA
Mailing Address - Zip Code:91912
Mailing Address - Country:US
Mailing Address - Phone:619-409-2096
Mailing Address - Fax:619-566-4877
Practice Address - Street 1:CALLE FRANCISCO JAVIER MINA NO. 1415
Practice Address - Street 2:EDIFICIO MEX CHINO INTERIOR 205
Practice Address - City:ZONA RIO, TIJUANA
Practice Address - State:B.C.
Practice Address - Zip Code:22010
Practice Address - Country:MX
Practice Address - Phone:664-340-7953
Practice Address - Fax:619-566-4877
Is Sole Proprietor?:Yes
Enumeration Date:2023-05-19
Last Update Date:2023-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ZZSEPCEDULA37035601223E0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223E0200XDental ProvidersDentistEndodonticsGroup - Single Specialty