Healthcare Provider Details

I. General information

NPI: 1174106165
Provider Name (Legal Business Name): THOMAS JAMES RUGGIERO NP
Entity Type: Individual
Gender: Male
Sole Proprietor: N

Provider Other Name: MR. T J RUGGIERO

II. Dates (important events)

Enumeration Date: 04/28/2021
Last Update Date: 04/28/2021
Certification Date: 03/10/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6411 FANNIN ST
HOUSTON TX
77030-1501
US

IV. Provider business mailing address

6400 FANNIN ST STE 2070
HOUSTON TX
77030-1541
US

V. Phone/Fax

Practice location:
  • Phone: 713-486-8000
  • Fax: 713-486-8088
Mailing address:
  • Phone: 713-486-8000
  • Fax: 713-500-0871

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number874842
License Number StateTX
# 2
Primary TaxonomyY
Taxonomy Code363LA2100X
TaxonomyAcute Care Nurse Practitioner
License Number1035477
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: