Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2080A0000X | Adolescent Medicine | L2138 | TX |
NPI | 1043387418 |
---|---|
Provider Name | Ruth Bernal |
First Address | El Paso, TX 79925-8096 |
Second Address | El Paso, TX 79915-4705 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 29/11/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
F72185 | (02) |