Healthcare Provider Details

I. General information

NPI: 1508613472
Provider Name (Legal Business Name): RIO GRANDE ANESTHESIA & PAIN MEDICINE CONSULTANTS, P .A.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/30/2024
Last Update Date: 04/30/2024
Certification Date: 04/30/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2820 MICHAELANGELO DR
EDINBURG TX
78539-1402
US

IV. Provider business mailing address

PO BOX 1230
SAN ANTONIO TX
78294-1230
US

V. Phone/Fax

Practice location:
  • Phone: 956-632-6020
  • Fax:
Mailing address:
  • Phone: 956-632-6020
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207LP3000X
TaxonomyPediatric Anesthesiology Physician
License Number
License Number State

VIII. Authorized Official

Name: DANIEL REQUENEZ
Title or Position: PRESIDENT
Credential: MD
Phone: 956-632-6020