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General NPI Number Information
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NPI Number | 1124934948
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Entity Type | Organization
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Legal Business Name | RUSTIC ROOTS FAMILY CARE PLLC
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Dates
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Enumeration Date | 08/21/2026
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Last Update Date | 08/21/2026
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Provider Practice Location Address
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Address Line | 1328 HERITAGE BLVD
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City | LONGVIEW
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State | TX
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Zip | 75605-1472
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Country | US
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Telephone | 512-952-2894
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 162
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City | WHITE OAK
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State | TX
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Zip | 75693-0162
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Country | US
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Telephone | 512-952-2894
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | CARL CINI
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Credential |
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Telephone | 512-952-2894
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101Y00000X
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Taxonomy Name | Counselor
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 363LP2300X
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Taxonomy Name | Primary Care Nurse Practitioner
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License Number |
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License Number State |
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