Provider Demographics
NPI:1215533344
Name:RUEDA ESCOBAR, JULIO ALBERTO
Entity Type:Individual
Prefix:
First Name:JULIO
Middle Name:ALBERTO
Last Name:RUEDA ESCOBAR
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5012 ELGIN ST
Mailing Address - Street 2:
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76105
Mailing Address - Country:US
Mailing Address - Phone:214-859-2519
Mailing Address - Fax:
Practice Address - Street 1:5012 ELGIN ST
Practice Address - Street 2:
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76105
Practice Address - Country:US
Practice Address - Phone:214-859-2519
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-12-04
Last Update Date:2020-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1019341163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse