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NPI Code Detail

MEDICARE: PHYSICIAN CARE & DIAGNOSTICS CENTER, LLC

MEDICARE: PHYSICIAN CARE & DIAGNOSTICS CENTER, LLC
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1246XS1301XSonography Specialist/Technologist CardiovascularTX

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
10330DCOTHERTXBC/BS OF TEXAS
2MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1124004148
Entity Type Code : Organization
Provider Name (Legal Business Name) : PHYSICIAN CARE & DIAGNOSTICS CENTER, LLC
Provider Business Mailing Address
First Line : PO BOX 420719
Second Line :
City : HOUSTON
State : TX
Zip : 77242-0719
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 3829 SARATOGA BLVD
Second Line :
City : CORPUS CHRISTI
State : TX
Zip : 78415-5814
Country : US
Telephone Number : 361-225-2624
Fax Number :
Authorized Official
Title or Position : MEMBER
Name : MR. RODOLFO MALDONADO
Credential :
Telephone Number : 832-692-6560
Provider Enumeration Date : 12/21/2005
Last Update Date : 02/11/2014

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Directions to “PHYSICIAN CARE & DIAGNOSTICS CENTER, LLC ” Practice Location

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