Healthcare Provider Details

I. General information

NPI: 1396214706
Provider Name (Legal Business Name): ROGER DEHOYOS APRN
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/14/2018
Last Update Date: 07/03/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1313 VETERANS AVE STE A
CRYSTAL CITY TX
78839-1651
US

IV. Provider business mailing address

PO BOX 278
CARRIZO SPRINGS TX
78834-6278
US

V. Phone/Fax

Practice location:
  • Phone: 830-374-9823
  • Fax: 830-374-9858
Mailing address:
  • Phone: 830-876-9458
  • Fax: 830-876-2411

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LG0600X
TaxonomyGerontology Nurse Practitioner
License NumberAP139729
License Number StateTX
# 2
Primary TaxonomyY
Taxonomy Code363LA2100X
TaxonomyAcute Care Nurse Practitioner
License NumberAP139729
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: