Healthcare Provider Details

I. General information

NPI: 1215650668
Provider Name (Legal Business Name): RGV HEALTH MEDICAL CLINIC, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/21/2022
Last Update Date: 12/07/2022
Certification Date: 12/07/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

832 RIDGEWOOD ST STE B
BROWNSVILLE TX
78520-0102
US

IV. Provider business mailing address

832 RIDGEWOOD ST STE B
BROWNSVILLE TX
78520-0102
US

V. Phone/Fax

Practice location:
  • Phone: 956-667-5298
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QP2300X
TaxonomyPrimary Care Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: RAFAEL OTERO
Title or Position: OWNER / PHYSICIAN
Credential: MD
Phone: 956-545-5036