Healthcare Provider Details

I. General information

NPI: 1003968744
Provider Name (Legal Business Name): KARIN RUCKGABER PEREZ RN, CPNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/16/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3311 FM 973
DEL VALLE TX
78617-3600
US

IV. Provider business mailing address

17410 TOYAHVILLE
ROUND ROCK TX
78664-7396
US

V. Phone/Fax

Practice location:
  • Phone: 512-386-3335
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License Number690890
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: