Provider Demographics
NPI:1093417115
Name:SMITH, RUBY ROCHELLE
Entity Type:Individual
Prefix:
First Name:RUBY
Middle Name:ROCHELLE
Last Name:SMITH
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 1:6200 LOYOLA LN APT 1232
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78724-3536
Mailing Address - Country:US
Mailing Address - Phone:512-949-7565
Mailing Address - Fax:
Practice Address - Street 1:6200 LOYOLA LN APT 1232
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78724-3536
Practice Address - Country:US
Practice Address - Phone:512-949-7565
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-03-21
Last Update Date:2023-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
No172A00000XOther Service ProvidersDriver
No343900000XTransportation ServicesNon-emergency Medical Transport (VAN)
No347C00000XTransportation ServicesPrivate Vehicle