Healthcare Provider Details

I. General information

NPI: 1194317271
Provider Name (Legal Business Name): VERONICA CAMPOS RUDDER
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/09/2021
Last Update Date: 02/09/2021
Certification Date: 02/09/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4171 N MESA ST STE 210
EL PASO TX
79902-1444
US

IV. Provider business mailing address

6436 TARASCAS DR
EL PASO TX
79912-2525
US

V. Phone/Fax

Practice location:
  • Phone: 915-545-1955
  • Fax:
Mailing address:
  • Phone: 915-581-3290
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number27162
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: