Healthcare Provider Details

I. General information

NPI: 1851726780
Provider Name (Legal Business Name): AMANDO ALBERTO URESTI P.A.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/11/2013
Last Update Date: 09/17/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2952 BOCA CHICA BLVD
BROWNSVILLE TX
78521
US

IV. Provider business mailing address

2952 BOCA CHICA BLVD
BROWNSVILLE TX
78521-3506
US

V. Phone/Fax

Practice location:
  • Phone: 956-243-8888
  • Fax: 956-243-8889
Mailing address:
  • Phone: 956-243-8888
  • Fax: 956-243-8889

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA08473
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: