Healthcare Provider Details

I. General information

NPI: 1710707583
Provider Name (Legal Business Name): RUDELAY ROQUE FERNANDEZ
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/15/2024
Last Update Date: 08/07/2026
Certification Date: 08/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

22325 GOSLING RD
SPRING TX
77389-4409
US

IV. Provider business mailing address

22325 GOSLING RD
SPRING TX
77389-4409
US

V. Phone/Fax

Practice location:
  • Phone: 281-724-7980
  • Fax:
Mailing address:
  • Phone: 281-724-7980
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number1039068
License Number StateTX
# 2
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number1039068
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: