Healthcare Provider Details

I. General information

NPI: 1740008549
Provider Name (Legal Business Name): ALEJANDRO RUIZ DE SOMOCURCIO CRNA
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/30/2024
Last Update Date: 10/16/2024
Certification Date: 10/16/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1500 S MAIN ST
FORT WORTH TX
76104-4941
US

IV. Provider business mailing address

3248 W 7TH ST APT 544
FORT WORTH TX
76107-2818
US

V. Phone/Fax

Practice location:
  • Phone: 817-965-1328
  • Fax:
Mailing address:
  • Phone: 469-667-1994
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WC0200X
TaxonomyCritical Care Medicine Registered Nurse
License Number905208
License Number StateTX
# 2
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number1177825
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: