Provider Demographics
NPI:1730284555
Name:RUIBAL, CALIXTO J (MD)
Entity Type:Individual
Prefix:
First Name:CALIXTO
Middle Name:J
Last Name:RUIBAL
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7109-B LAWNDALE
Mailing Address - Street 2:LAWNDALE MEDICAL CLINIC
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77023
Mailing Address - Country:US
Mailing Address - Phone:713-924-4907
Mailing Address - Fax:713-924-4182
Practice Address - Street 1:7109-B LAWNDALE
Practice Address - Street 2:LAWNDALE MEDICAL CLINIC
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77023
Practice Address - Country:US
Practice Address - Phone:713-924-4907
Practice Address - Fax:713-924-4182
Is Sole Proprietor?:No
Enumeration Date:2006-09-14
Last Update Date:2012-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXG0921207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX121482701Medicaid
80C766Medicare ID - Type Unspecified
B26060Medicare UPIN