1528759461 NPI number — RUTH EDITH RODRUGUEZ GUEVARA M.D.

Table of content: RUTH EDITH RODRUGUEZ GUEVARA M.D. (NPI 1528759461)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1528759461 NPI number — RUTH EDITH RODRUGUEZ GUEVARA M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
RODRUGUEZ GUEVARA
Provider First Name:
RUTH
Provider Middle Name:
EDITH
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
M.D.
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1528759461
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
05/19/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 120123
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CHULA VISTA
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
91912
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
619-409-2096
Provider Business Mailing Address Fax Number:
619-566-4877

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
CALLE FRANCISCO JAVIER MINA NO. 1415
Provider Second Line Business Practice Location Address:
EDIFICIO MEX CHINO INTERIOR 205
Provider Business Practice Location Address City Name:
ZONA RIO, TIJUANA
Provider Business Practice Location Address State Name:
B.C.
Provider Business Practice Location Address Postal Code:
22010
Provider Business Practice Location Address Country Code:
MX
Provider Business Practice Location Address Telephone Number:
664-340-7953
Provider Business Practice Location Address Fax Number:
619-566-4877
Provider Enumeration Date:
05/19/2023

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 1223E0200X , with the licence number:  SEPCEDULA3703560 , registered in the state of ZZ ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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