Healthcare Provider Details

I. General information

NPI: 1649974106
Provider Name (Legal Business Name): JOEL PEREZ RODRIGUEZ
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/29/2023
Last Update Date: 03/29/2023
Certification Date: 03/29/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

AVENIDA MIGUEL ALEMAN #103
REYNOSA TAMAULIPAS
88550
MX

IV. Provider business mailing address

410 S 15TH ST SUITE 2261
MCALLEN TX
78501
US

V. Phone/Fax

Practice location:
  • Phone: 899-206-9138
  • Fax: 619-354-2449
Mailing address:
  • Phone: 899-206-9138
  • Fax: 619-354-2449

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number
License Number State

VIII. Authorized Official

Name: DR. JOEL PEREZ RODRIGUEZ
Title or Position: OWNER
Credential:
Phone: 619-349-6409