Healthcare Provider Details

I. General information

NPI: 1124751896
Provider Name (Legal Business Name): PROFESSIONAL PSYCHIATRIC ASSOCIATES OF RGV, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/08/2022
Last Update Date: 10/17/2022
Certification Date: 10/05/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

104 NORTH SALINAS BLVD SUITE-A
DONNA TX
78537
US

IV. Provider business mailing address

104 NORTH SALINAS BLVD SUITE -A
DONNA TX
78537
US

V. Phone/Fax

Practice location:
  • Phone: 956-377-5400
  • Fax: 956-377-5509
Mailing address:
  • Phone: 956-377-5710
  • Fax: 956-377-5509

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State

VIII. Authorized Official

Name: MICHAEL A FLORES
Title or Position: OWNER
Credential: MD
Phone: 956-377-5400