MEDICARE: MCALLEN DIAGNOSTICS 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
1	207Q00000X	Family Medicine Physician		TX

General Provider Information

NPI Number	:	1447674197
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MCALLEN DIAGNOSTICS LLC

Provider Business Mailing Address
First Line	:	2010 S CYNTHIA ST STE 110
Second Line	:
City	:	MCALLEN
State	:	TX
Zip	:	78503-1387
Country	:	US
Telephone Number	:	956-687-6963
Fax Number	:	956-683-7185

Provider Business Practice Location Address
First Line	:	2000 S MCCOLL RD STE B
Second Line	:
City	:	MCALLEN
State	:	TX
Zip	:	78503-1516
Country	:	US
Telephone Number	:	956-342-1244
Fax Number	:	956-683-7185

Authorized Official
Title or Position	:	PRESIDENT
Name	:	BRENDA PEREZ
Credential	:
Telephone Number	:	956-342-1244

Provider Enumeration Date	:	02/14/2014
Last Update Date	:	02/14/2014

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Directions to “MCALLEN DIAGNOSTICS LLC ” Practice Location

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