Healthcare Provider Details

I. General information

NPI: 1396067039
Provider Name (Legal Business Name): ROGELIO RUVALCABA RD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/23/2010
Last Update Date: 02/23/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7091 E SPEEDWAY BLVD
TUCSON AZ
85710-1241
US

IV. Provider business mailing address

7091 E SPEEDWAY BLVD
TUCSON AZ
85710-1241
US

V. Phone/Fax

Practice location:
  • Phone: 520-721-5777
  • Fax:
Mailing address:
  • Phone: 520-721-5777
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: