Healthcare Provider Details

I. General information

NPI: 1568477321
Provider Name (Legal Business Name): RADU I CIUBUC MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/30/2006
Last Update Date: 08/31/2022
Certification Date: 11/10/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

125 W HAGUE RD STE 130
EL PASO TX
79902-5814
US

IV. Provider business mailing address

8001EN MESA ST 320
EL PASO TX
79932-1627
US

V. Phone/Fax

Practice location:
  • Phone: 915-217-2163
  • Fax: 915-217-2166
Mailing address:
  • Phone: 915-217-2163
  • Fax: 915-217-2166

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RG0300X
TaxonomyGeriatric Medicine (Internal Medicine) Physician
License NumberK0685
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: