Provider Demographics
NPI:1093182776
Name:MTARUBUKWA, DORIS
Entity Type:Individual
Prefix:MRS
First Name:DORIS
Middle Name:
Last Name:MTARUBUKWA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:215 ROUND LAKE RD
Mailing Address - Street 2:
Mailing Address - City:ROSENBURG
Mailing Address - State:TX
Mailing Address - Zip Code:77469
Mailing Address - Country:US
Mailing Address - Phone:832-498-8834
Mailing Address - Fax:
Practice Address - Street 1:215 ROUND LAKE DR
Practice Address - Street 2:
Practice Address - City:ROSENBERG
Practice Address - State:TX
Practice Address - Zip Code:77469-1779
Practice Address - Country:US
Practice Address - Phone:832-498-8834
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-08-28
Last Update Date:2015-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAP127583363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily