Basic Information
| Provider Information | |||||||||
| NPI: | 1043570864 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | RUKASIN | ||||||||
| FirstName: | CHRISTINE | ||||||||
| MiddleName: | REGINA FUKUMOTO | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1919 E THOMAS RD | ||||||||
| Address2: | |||||||||
| City: | PHOENIX | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 850167710 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6029331000 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 1919 E THOMAS RD | ||||||||
| Address2: | |||||||||
| City: | PHOENIX | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 850167710 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6029330985 | ||||||||
| FaxNumber: | 6029332423 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/26/2012 | ||||||||
| LastUpdateDate: | 06/18/2021 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 06/18/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207RA0201X | 57762 | AZ | N | Allopathic & Osteopathic Physicians | Internal Medicine | Allergy & Immunology | 208000000X | 57762 | AZ | N | Allopathic & Osteopathic Physicians | Pediatrics | 2080N0001X | A129155 | CA | N | Allopathic & Osteopathic Physicians | Pediatrics | Neonatal-Perinatal Medicine | 207K00000X | 57762 | AZ | Y | Allopathic & Osteopathic Physicians | Allergy & Immunology |
No ID Information.