Provider Demographics
NPI:1003815499
Name:ALMANZA, RUBEN J (MD)
Entity Type:Individual
Prefix:
First Name:RUBEN
Middle Name:J
Last Name:ALMANZA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5446 LIPES BLVD STE 101
Mailing Address - Street 2:
Mailing Address - City:CORPUS CHRISTI
Mailing Address - State:TX
Mailing Address - Zip Code:78413-2509
Mailing Address - Country:US
Mailing Address - Phone:361-992-6100
Mailing Address - Fax:361-992-0665
Practice Address - Street 1:5446 LIPES BLVD STE 101
Practice Address - Street 2:
Practice Address - City:CORPUS CHRISTI
Practice Address - State:TX
Practice Address - Zip Code:78413-2509
Practice Address - Country:US
Practice Address - Phone:361-992-6100
Practice Address - Fax:361-992-0665
Is Sole Proprietor?:No
Enumeration Date:2005-07-18
Last Update Date:2020-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXK7644207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX178929901Medicaid
TXY38744Medicare UPIN
TX178929901Medicaid