Healthcare Provider Details

I. General information

NPI: 1598709149
Provider Name (Legal Business Name): RUTH A BERNARDEZ-TAN M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: RUTH A BERNARDEZ-TAN M.D.

II. Dates (important events)

Enumeration Date: 06/15/2006
Last Update Date: 11/30/2023
Certification Date: 11/30/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1915 E MAYFIELD RD STE 115
ARLINGTON TX
76014-2605
US

IV. Provider business mailing address

1915 E MAYFIELD RD STE 115
ARLINGTON TX
76014-2605
US

V. Phone/Fax

Practice location:
  • Phone: 682-276-6700
  • Fax: 682-276-6049
Mailing address:
  • Phone: 682-276-6700
  • Fax: 682-276-6049

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberJ8913
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: