Provider Demographics
NPI:1366229817
Name:RALLOS, ELMA (AGNP)
Entity type:Individual
Prefix:
First Name:ELMA
Middle Name:
Last Name:RALLOS
Suffix:
Gender:F
Credentials:AGNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13725 NORTHWEST BLVD STE II
Mailing Address - Street 2:
Mailing Address - City:CORPUS CHRISTI
Mailing Address - State:TX
Mailing Address - Zip Code:78410-5127
Mailing Address - Country:US
Mailing Address - Phone:361-767-6100
Mailing Address - Fax:361-767-6112
Practice Address - Street 1:13725 NORTHWEST BLVD STE II
Practice Address - Street 2:
Practice Address - City:CORPUS CHRISTI
Practice Address - State:TX
Practice Address - Zip Code:78410-5127
Practice Address - Country:US
Practice Address - Phone:361-767-6100
Practice Address - Fax:361-767-6112
Is Sole Proprietor?:No
Enumeration Date:2023-09-08
Last Update Date:2023-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1118054363LG0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology