MEDICARE: RIFA RUKNUDDIN MOMIN

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363AM0700X	Medical Physician Assistant	PA18416	TX
2	363A00000X	Physician Assistant	PA18416	TX

General Provider Information

NPI Number	:	1013726785
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	RIFA RUKNUDDIN MOMIN

Provider Business Mailing Address
First Line	:	201 E WILCO HWY STE 100
Second Line	:
City	:	HUTTO
State	:	TX
Zip	:	78634-2739
Country	:	US
Telephone Number	:	512-551-1090
Fax Number	:

Provider Business Practice Location Address
First Line	:	780 W BROADE ST STE 115
Second Line	:
City	:	LEANDER
State	:	TX
Zip	:	78641-6552
Country	:	US
Telephone Number	:	512-551-1090
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/06/2025
Last Update Date	:	01/21/2026

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Directions to “ RIFA RUKNUDDIN MOMIN ” Practice Location

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