Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LP0200X | Nurse Practitioner - Pediatrics | 690890 | TX |
NPI | 1003968744 |
---|---|
Provider Name | Karin Ruckgaber Perez |
First Address | Round Rock, TX 78664-7396 |
Second Address | Del Valle, TX 78617-3600 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 16/01/2007 |
Last Update Date | 08/07/2007 |