Healthcare Provider Details

I. General information

NPI: 1235566837
Provider Name (Legal Business Name): RUCHI S KUKREJA PSYD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/27/2013
Last Update Date: 09/27/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1110 NASA PARKWAY STE 307
HOUSTON TX
77058
US

IV. Provider business mailing address

1110 NASA PARKWAY STE 307
HOUSTON TX
77058
US

V. Phone/Fax

Practice location:
  • Phone: 281-956-1032
  • Fax: 281-956-1040
Mailing address:
  • Phone: 281-956-1032
  • Fax: 281-956-1040

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number36648
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: