Provider Demographics
NPI:1780194951
Name:RUDA, NATASHA ANDREA (PA)
Entity Type:Individual
Prefix:
First Name:NATASHA
Middle Name:ANDREA
Last Name:RUDA
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:15703 FERN RIDGE DR
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77084-3053
Mailing Address - Country:US
Mailing Address - Phone:832-566-2207
Mailing Address - Fax:
Practice Address - Street 1:3737 RED BLUFF RD STE 150
Practice Address - Street 2:
Practice Address - City:PASADENA
Practice Address - State:TX
Practice Address - Zip Code:77503-3307
Practice Address - Country:US
Practice Address - Phone:713-475-4224
Practice Address - Fax:713-473-7160
Is Sole Proprietor?:No
Enumeration Date:2017-10-02
Last Update Date:2018-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
363A00000X
TX363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant