Provider Demographics
NPI:1588423065
Name:VENEGAS, RUBEN JAMES
Entity type:Individual
Prefix:
First Name:RUBEN
Middle Name:JAMES
Last Name:VENEGAS
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5000 SANGER AVE APT 1621
Mailing Address - Street 2:
Mailing Address - City:WACO
Mailing Address - State:TX
Mailing Address - Zip Code:76710-8763
Mailing Address - Country:US
Mailing Address - Phone:830-515-2224
Mailing Address - Fax:
Practice Address - Street 1:7801 WOODWAY DR
Practice Address - Street 2:
Practice Address - City:WOODWAY
Practice Address - State:TX
Practice Address - Zip Code:76712-3860
Practice Address - Country:US
Practice Address - Phone:254-235-7801
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-03-18
Last Update Date:2024-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX218202224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant