Healthcare Provider Details

I. General information

NPI: 1346247301
Provider Name (Legal Business Name): MARCELINA RUPLEY M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/06/2005
Last Update Date: 09/12/2024
Certification Date: 09/12/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1016 N VIRGINIA ST
PORT LAVACA TX
77979-3000
US

IV. Provider business mailing address

1016 N VIRGINIA ST
PORT LAVACA TX
77979-3000
US

V. Phone/Fax

Practice location:
  • Phone: 361-552-0325
  • Fax: 361-500-6904
Mailing address:
  • Phone: 361-552-0325
  • Fax: 361-500-6904

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberJ2771
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: