Healthcare Provider Details

I. General information

NPI: 1245444744
Provider Name (Legal Business Name): CAPITAL NEUROSURGICAL ASSOCIATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/10/2007
Last Update Date: 02/24/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

711 WEST 38TH ST STE D-4
AUSTIN TX
78705
US

IV. Provider business mailing address

711 WEST 38TH ST STE D-4
AUSTIN TX
78705
US

V. Phone/Fax

Practice location:
  • Phone: 512-454-9627
  • Fax: 512-454-6310
Mailing address:
  • Phone: 512-454-9627
  • Fax: 512-454-6310

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207T00000X
TaxonomyNeurological Surgery Physician
License NumberD0073
License Number StateTX

VIII. Authorized Official

Name: MR. RUEBEN RIVERA
Title or Position: OFFICE MANAGER
Credential:
Phone: 512-454-9627