Basic Information
| Provider Information | |||||||||
| NPI: | 1689966780 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | PEDRAZA | ||||||||
| FirstName: | RUBEN | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | JR. | ||||||||
| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1660 S STAPLES ST | ||||||||
| Address2: | STE 150 | ||||||||
| City: | CORPUS CHRISTI | ||||||||
| State: | TX | ||||||||
| PostalCode: | 784043156 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3618008155 | ||||||||
| FaxNumber: | 3618822590 | ||||||||
| Practice Location | |||||||||
| Address1: | 917 S PORT AVE | ||||||||
| Address2: | |||||||||
| City: | CORPUS CHRISTI | ||||||||
| State: | TX | ||||||||
| PostalCode: | 784052301 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3618831879 | ||||||||
| FaxNumber: | 3618831881 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/07/2011 | ||||||||
| LastUpdateDate: | 01/31/2017 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | N9480 | TX | Y | Allopathic & Osteopathic Physicians | Family Medicine | 208M00000X | N9480 | TX | N | Allopathic & Osteopathic Physicians | Hospitalist |
No ID Information.