Provider Demographics
NPI:1518012558
Name:CALIXTO J RUIBAL MD PA
Entity Type:Organization
Organization Name:CALIXTO J RUIBAL MD PA
Other - Org Name:LAWNDALE MEDICAL CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:CALIXTO
Authorized Official - Middle Name:JORGE
Authorized Official - Last Name:RUIBAL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:832-200-1646
Mailing Address - Street 1:7109 LAWNDALE ST
Mailing Address - Street 2:SUITE B
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77023-4248
Mailing Address - Country:US
Mailing Address - Phone:832-200-1646
Mailing Address - Fax:832-200-1660
Practice Address - Street 1:7109 LAWNDALE ST
Practice Address - Street 2:SUITE B
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77023-4248
Practice Address - Country:US
Practice Address - Phone:832-200-1646
Practice Address - Fax:832-200-1660
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-23
Last Update Date:2011-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXG0921207Q00000X, 261Q00000X
TXJ9368207Q00000X
TXH0743207Q00000X
TXK1780207R00000X
TXE6843207RC0000X
TXE9383207RG0100X
TXE3766207VG0400X
TXK6707208000000X
TXG7822208600000X
TXL8425208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
No207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
No207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular DiseaseGroup - Multi-Specialty
No207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterologyGroup - Multi-Specialty
No207VG0400XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGynecologyGroup - Multi-Specialty
No208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Multi-Specialty
No208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Multi-Specialty
No208800000XAllopathic & Osteopathic PhysiciansUrologyGroup - Multi-Specialty
No261Q00000XAmbulatory Health Care FacilitiesClinic/CenterGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX085095001Medicaid
TX00SW30Medicare ID - Type Unspecified