Provider Demographics
NPI:1447441092
Name:RUELAS, GREGORIO (MD)
Entity type:Individual
Prefix:DR
First Name:GREGORIO
Middle Name:
Last Name:RUELAS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:10885 TELEGRAPH RD
Mailing Address - Street 2:
Mailing Address - City:VENTURA
Mailing Address - State:CA
Mailing Address - Zip Code:93004-1272
Mailing Address - Country:US
Mailing Address - Phone:805-647-7704
Mailing Address - Fax:805-647-7084
Practice Address - Street 1:1751 LOMBARD ST
Practice Address - Street 2:
Practice Address - City:OXNARD
Practice Address - State:CA
Practice Address - Zip Code:93030-8266
Practice Address - Country:US
Practice Address - Phone:805-981-9111
Practice Address - Fax:833-916-2152
Is Sole Proprietor?:No
Enumeration Date:2007-08-08
Last Update Date:2021-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA95991207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAA95991OtherLICENSE NUMBER