Provider Demographics
NPI:1639711997
Name:MOCZYGEMBA, RUDOLPH (RRT)
Entity Type:Individual
Prefix:MR
First Name:RUDOLPH
Middle Name:
Last Name:MOCZYGEMBA
Suffix:
Gender:M
Credentials:RRT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6814 BROOKPORT
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78238-3018
Mailing Address - Country:US
Mailing Address - Phone:210-213-1497
Mailing Address - Fax:
Practice Address - Street 1:6814 BROOKPORT
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78238-3018
Practice Address - Country:US
Practice Address - Phone:210-213-1497
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-10-08
Last Update Date:2019-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RCP00062964227900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes227900000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRespiratory Therapist, RegisteredGroup - Single Specialty