Provider Demographics
NPI:1184688608
Name:RUBANO, JUDITH E (MD)
Entity Type:Individual
Prefix:
First Name:JUDITH
Middle Name:E
Last Name:RUBANO
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1533 S BROWNLEE BLVD
Mailing Address - Street 2:STE 100
Mailing Address - City:CORPUS CHRISTI
Mailing Address - State:TX
Mailing Address - Zip Code:78404-3131
Mailing Address - Country:US
Mailing Address - Phone:361-884-2242
Mailing Address - Fax:
Practice Address - Street 1:1533 S BROWNLEE BLVD STE 100
Practice Address - Street 2:
Practice Address - City:CORPUS CHRISTI
Practice Address - State:TX
Practice Address - Zip Code:78404-3131
Practice Address - Country:US
Practice Address - Phone:361-884-2242
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-04-13
Last Update Date:2023-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC15556207R00000X
TXS6501207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC155564Medicaid
SC155564Medicaid