Provider Demographics
NPI:1275829939
Name:RABARA, KNIC CORPUZ (DO)
Entity Type:Individual
Prefix:DR
First Name:KNIC
Middle Name:CORPUZ
Last Name:RABARA
Suffix:
Gender:M
Credentials:DO
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Mailing Address - Street 1:18700 KATY FWY
Mailing Address - Street 2:MOB 3, SUITE 403
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77094
Mailing Address - Country:US
Mailing Address - Phone:832-522-8444
Mailing Address - Fax:832-522-8445
Practice Address - Street 1:18700 KATY FWY
Practice Address - Street 2:MOB 3, SUITE 403
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77094
Practice Address - Country:US
Practice Address - Phone:832-522-8444
Practice Address - Fax:832-522-8445
Is Sole Proprietor?:No
Enumeration Date:2011-06-21
Last Update Date:2024-03-14
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
NJ25MB09366700204D00000X, 207Q00000X
TXR7574207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No204D00000XAllopathic & Osteopathic PhysiciansNeuromusculoskeletal Medicine & OMM
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0436011Medicaid
NJ379962Medicare PIN