Healthcare Provider Details

I. General information

NPI: 1104215094
Provider Name (Legal Business Name): MRS. ROBIN MOORE RUZIC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/14/2015
Last Update Date: 01/14/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

333 N RIVERSHIRE DR #210
CONROE TX
77304-0001
US

IV. Provider business mailing address

333 N RIVERSHIRE DR #210
CONROE TX
77304-0001
US

V. Phone/Fax

Practice location:
  • Phone: 936-494-0570
  • Fax:
Mailing address:
  • Phone: 936-494-0570
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number108084
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: