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General NPI Number Information
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NPI Number | 1154069466
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Entity Type | Individual
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Provider Name | RICARDO CHUJUTALLI MD
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Gender | Male
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Dates
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Enumeration Date | 05/25/2022
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Last Update Date | 07/14/2025
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Provider Practice Location Address
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Address Line | 1670 E BROAD ST STE 110
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City | MANSFIELD
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State | TX
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Zip | 76063-1862
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Country | US
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Telephone | 682-341-7510
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Fax |
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Provider Business Mailing Address
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Address Line | 4924 MARSH HARRIER AVE.
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City | GRAND PRAIRIE
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State | TX
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Zip | 75052
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | V9870
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License Number State | TX
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