Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207K00000X | Allergist & Immunologist | 57762 | AZ |
N | 207RA0201X | Internist - Allergy & Immunology | 57762 | AZ |
N | 208000000X | Pediatrician | 57762 | AZ |
N | 2080N0001X | Neonatal-Perinatal Doctor | A129155 | CA |
NPI | 1043570864 |
---|---|
Provider Name | Christine Regina Fukumoto Rukasin |
First Address | Phoenix, AZ 85016-7710 |
Second Address | Phoenix, AZ 85016-7710 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 26/05/2012 |
Last Update Date | 18/06/2021 |