Tina Nicolette Rueda

Primary specialty

Community Health WorkerTaxonomy code 172V00000X

Practice address

137 E Oak St
Fort Bragg, CA 95437-3610

Phone

(707) 345-4012

NPI assigned

Mar 22, 2021

Sex

Female

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Mendocino Coast Hospitality Center

  • Community/Behavioral Health Agency
  • Fort Bragg, CA
  • NPI 1902357437
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1616371200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1720569600000",
    "number": "1851977607",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "137 E OAK ST",
            "city": "FORT BRAGG",
            "state": "CA",
            "postal_code": "954373610",
            "telephone_number": "707-345-4012"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "137 E OAK ST",
            "city": "FORT BRAGG",
            "state": "CA",
            "postal_code": "954373610",
            "telephone_number": "707-345-4012"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "RUEDA",
        "first_name": "TINA",
        "middle_name": "NICOLETTE",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2021-03-22",
        "last_updated": "2024-07-10",
        "certification_date": "2024-07-10",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "172V00000X",
            "taxonomy_group": "",
            "desc": "Community Health Worker",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "103K00000X",
            "taxonomy_group": "",
            "desc": "Behavior Analyst",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• John Arthur Rochat, M.D.
• Roderick E McMillen DDS a Dental Corp
• Victor Manuel Rodriguez
• Mary Rosenthal
• Glenn Alfred Rude, MFC
• Russell Perry MD, a Medical Corporation
• Robert W Ryder, MD
• Richard Sacks-Wilner, MD
• Safeway Inc
• Jennifer Lynn Sallee

• Community Health Worker in Fort Bragg, CA
• Providers in Fort Bragg, CA by specialty
• Community Health Worker in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 10, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.