Healthcare Provider Details

I. General information

NPI: 1104096080
Provider Name (Legal Business Name): RG MERIDIAN HEALTH CARE SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/06/2008
Last Update Date: 03/06/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2804A ALPHA GRANDVIEW CONDOMINIUM
MANILA METROMANILA
1001
PH

IV. Provider business mailing address

2804A ALPHA GRANDVIEW CONDOMINIUM
MANILA METROMANILA
1001
PH

V. Phone/Fax

Practice location:
  • Phone: 632-522-4738
  • Fax: 632-522-4738
Mailing address:
  • Phone: 632-522-4738
  • Fax: 632-522-4738

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License NumberPHL042238
License Number StateTX

VIII. Authorized Official

Name: MR. RENE FERNANDEZ GAVIOLA
Title or Position: PRESIDENT
Credential:
Phone: 632-522-4738