Provider Demographics
NPI:1699120311
Name:HEPBURN-RUEDA, ALEXANDRIA ELIZABETH (DPM)
Entity type:Individual
Prefix:DR
First Name:ALEXANDRIA
Middle Name:ELIZABETH
Last Name:HEPBURN-RUEDA
Suffix:
Gender:F
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1908 MACDADE BLVD STE A
Mailing Address - Street 2:
Mailing Address - City:FOLSOM
Mailing Address - State:PA
Mailing Address - Zip Code:19033-1316
Mailing Address - Country:US
Mailing Address - Phone:215-391-9583
Mailing Address - Fax:
Practice Address - Street 1:1908 MACDADE BLVD STE A
Practice Address - Street 2:
Practice Address - City:FOLSOM
Practice Address - State:PA
Practice Address - Zip Code:19033-1316
Practice Address - Country:US
Practice Address - Phone:215-391-9583
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-05-01
Last Update Date:2020-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASC006693213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist