MEDICARE: ROEL CONTRERAS

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
1	363A00000X	Physician Assistant	PA01794	TX

General Provider Information

NPI Number	:	1336353390
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ROEL CONTRERAS

Provider Business Mailing Address
First Line	:	801 E NOLANA AVE STE 9
Second Line	:
City	:	MCALLEN
State	:	TX
Zip	:	78504-6113
Country	:	US
Telephone Number	:	956-668-7333
Fax Number	:	956-668-7999

Provider Business Practice Location Address
First Line	:	801 E NOLANA AVE STE 9
Second Line	:
City	:	MCALLEN
State	:	TX
Zip	:	78504-6113
Country	:	US
Telephone Number	:	956-668-7333
Fax Number	:	956-668-7999

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/09/2007
Last Update Date	:	11/19/2013

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Practice Location Address:

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1366633513 — PERFORMANCE ENHANCING NUTRITION
Practice Location Address:

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Directions to “ ROEL CONTRERAS ” Practice Location

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