Healthcare Provider Details

I. General information

NPI: 1033772801
Provider Name (Legal Business Name): LV IMAGING II, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/17/2019
Last Update Date: 04/17/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1900 N EXPRESSWAY # 77B-2
BROWNSVILLE TX
78521-1556
US

IV. Provider business mailing address

1900 N EXPRESSWAY # 77B-2
BROWNSVILLE TX
78521-1556
US

V. Phone/Fax

Practice location:
  • Phone: 956-548-1199
  • Fax: 956-548-1198
Mailing address:
  • Phone: 956-548-1199
  • Fax: 956-548-1198

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: CARLOS VILLARREAL
Title or Position: MANAGER
Credential:
Phone: 956-466-7221