Healthcare Provider Details

I. General information

NPI: 1275256265
Provider Name (Legal Business Name): RENE BADILLO II
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/23/2022
Last Update Date: 05/07/2026
Certification Date: 05/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2020 FM 967
BUDA TX
78610-2877
US

IV. Provider business mailing address

3601 ANDREWS HWY APT 1502
MIDLAND TX
79703-4958
US

V. Phone/Fax

Practice location:
  • Phone: 512-580-4399
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA17236
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: