Provider Demographics
NPI:1871048132
Name:PUEBLO Y SALUD, INC
Entity type:Organization
Organization Name:PUEBLO Y SALUD, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:RUBEN
Authorized Official - Middle Name:R
Authorized Official - Last Name:RODRIGUEZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:818-837-2272
Mailing Address - Street 1:1024 N MACLAY AVE
Mailing Address - Street 2:STE. M-13
Mailing Address - City:SAN FERNANDO
Mailing Address - State:CA
Mailing Address - Zip Code:91340-1361
Mailing Address - Country:US
Mailing Address - Phone:818-837-2272
Mailing Address - Fax:818-837-2271
Practice Address - Street 1:1024 N MACLAY AVE
Practice Address - Street 2:STE. M-13
Practice Address - City:SAN FERNANDO
Practice Address - State:CA
Practice Address - Zip Code:91340-1361
Practice Address - Country:US
Practice Address - Phone:818-837-2272
Practice Address - Fax:818-837-2271
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-08-16
Last Update Date:2016-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA251K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251K00000XAgenciesPublic Health or Welfare