Provider Demographics
NPI:1942869466
Name:RUELAS, JOSHUA AARON (ATC)
Entity type:Individual
Prefix:
First Name:JOSHUA
Middle Name:AARON
Last Name:RUELAS
Suffix:
Gender:M
Credentials:ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:201 E CHAPMAN AVE APT 32G
Mailing Address - Street 2:
Mailing Address - City:PLACENTIA
Mailing Address - State:CA
Mailing Address - Zip Code:92870-4614
Mailing Address - Country:US
Mailing Address - Phone:559-799-7187
Mailing Address - Fax:
Practice Address - Street 1:4771 CAMPUS DR
Practice Address - Street 2:
Practice Address - City:IRVINE
Practice Address - State:CA
Practice Address - Zip Code:92612-3298
Practice Address - Country:US
Practice Address - Phone:949-936-7791
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-06-08
Last Update Date:2023-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Provider Identifiers
StateIdentifier IDID TypeIssuer
2000042353OtherBOARD OF CERTIFICATION