1740626340 NPI number — MARIO R ANZALDUA MD PA

Table of content: DR. ARMANDO FRANCISCO RODRIGUEZ LOPEZ MD (NPI 1841781200)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1740626340 NPI number — MARIO R ANZALDUA MD PA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
MARIO R ANZALDUA MD 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:
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:
1740626340
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
10/19/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1512 E GRIFFIN PKWY STE 2
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MISSION
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
78572-2422
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
956-519-7088
Provider Business Mailing Address Fax Number:
956-519-9816

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1512 E GRIFFIN PKWY STE 2
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MISSION
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
78572-2422
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
956-519-7088
Provider Business Practice Location Address Fax Number:
956-519-9816
Provider Enumeration Date:
05/22/2013

Additional Information

Authorized Official

Authorized Official Last Name:
ANZALDUA
Authorized Official First Name:
MARIO
Authorized Official Middle Name:
R
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
956-519-7088

Provider Taxonomy Codes

  • Taxonomy code: 207Q00000X , with the licence number:  F9142 , 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: F9142 . This is a "MEDICAL LICENSE" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".




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