Provider Demographics
NPI:1730226218
Name:RUELAZ, EVELYN ANNA (MD)
Entity type:Individual
Prefix:DR
First Name:EVELYN
Middle Name:ANNA
Last Name:RUELAZ
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:2101 EAST JEFFERSON STREET
Mailing Address - Street 2:KAISER PERMANENTE, PPQA, 6 WEST, ATTN: THERESA BROOKS
Mailing Address - City:ROCKVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:20852
Mailing Address - Country:US
Mailing Address - Phone:301-181-6660
Mailing Address - Fax:301-816-6308
Practice Address - Street 1:11730 SUDLEY MANOR DRIVE
Practice Address - Street 2:
Practice Address - City:MANASSAS
Practice Address - State:VA
Practice Address - Zip Code:20109
Practice Address - Country:US
Practice Address - Phone:703-257-3001
Practice Address - Fax:703-257-3133
Is Sole Proprietor?:No
Enumeration Date:2007-01-31
Last Update Date:2021-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101057488207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
G70321Medicare UPIN
16000154Medicare ID - Type Unspecified