Healthcare Provider Details

I. General information

NPI: 1720056609
Provider Name (Legal Business Name): RUDY WILBERT AROCHA OTHER
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 03/08/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

BRANCH HEALTH CLINIC 327 CORAL SEA DR. SUITE 165
INGLESIDE TX
78362
US

IV. Provider business mailing address

108 W JANIN CIR
PORTLAND TX
78374-1414
US

V. Phone/Fax

Practice location:
  • Phone: 361-776-1107
  • Fax:
Mailing address:
  • Phone: 361-776-1107
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1710I1002X
TaxonomyIndependent Duty Corpsman
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: