Provider Demographics
NPI:1407034739
Name:PERALES, RUBEN GONZALES (RD, LD, CNSD)
Entity Type:Individual
Prefix:MR
First Name:RUBEN
Middle Name:GONZALES
Last Name:PERALES
Suffix:
Gender:M
Credentials:RD, LD, CNSD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6161 ANGUS DR
Mailing Address - Street 2:
Mailing Address - City:CORPUS CHRISTI
Mailing Address - State:TX
Mailing Address - Zip Code:78415-5673
Mailing Address - Country:US
Mailing Address - Phone:361-855-7043
Mailing Address - Fax:
Practice Address - Street 1:6161 ANGUS DR
Practice Address - Street 2:
Practice Address - City:CORPUS CHRISTI
Practice Address - State:TX
Practice Address - Zip Code:78415-5673
Practice Address - Country:US
Practice Address - Phone:361-585-3028
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-02-08
Last Update Date:2018-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXDT07692133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered