1316239155 NPI number — LAREDO MINOR EMERGENCY CLINIC, PA

Table of content: MAYA DE RASHAD RD,LD (NPI 1871272294)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1316239155 NPI number — LAREDO MINOR EMERGENCY CLINIC, PA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
LAREDO MINOR EMERGENCY CLINIC, PA
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
6
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1316239155
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/30/2019
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
904 CORPUS CHRISTI ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
LAREDO
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
78040-5277
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
956-725-0300
Provider Business Mailing Address Fax Number:
956-722-6174

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
904 CORPUS CHRISTI ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LAREDO
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
78040-5277
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
956-725-0300
Provider Business Practice Location Address Fax Number:
956-722-6174
Provider Enumeration Date:
05/12/2011

Additional Information

Authorized Official

Authorized Official Last Name:
CARDENAS
Authorized Official First Name:
MELCHOR
Authorized Official Middle Name:
PABLO
Authorized Official Title or Position:
MEDICAL DOCTOR
Authorized Official Telephone Number:
956-725-0300

Provider Taxonomy Codes

  • Taxonomy code: 207Q00000X , with the licence number:  K8049 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 353461201 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".




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