Healthcare Provider Details

I. General information

NPI: 1275706756
Provider Name (Legal Business Name): BECKY SUZZANNE RUBIN CRNA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: BECKY TOUSSANT

II. Dates (important events)

Enumeration Date: 04/07/2008
Last Update Date: 12/14/2021
Certification Date: 12/14/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1004 SOUTH ROCK STREET WESTLAKE ANESTHESIA GROUP, PA
GEORGETOWN TX
78626
US

IV. Provider business mailing address

1004 SOUTH ROCK STREET WESTLAKE ANESTHESIA GROUP, PA
GEORGETOWN TX
78626
US

V. Phone/Fax

Practice location:
  • Phone: 512-279-0348
  • Fax: 512-371-8788
Mailing address:
  • Phone: 512-279-0348
  • Fax: 512-371-8788

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number639142
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number080884
License Number StateCA
# 3
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License NumberAP122966
License Number StateTX
# 4
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number227332
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: