Healthcare Provider Details

I. General information

NPI: 1861455735
Provider Name (Legal Business Name): EDINBURG OBSTETRICS, GYNECEOLOGY & INFERTILITY CLINIC PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/10/2006
Last Update Date: 05/03/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

910 S CLOSNER BLVD
EDINBURG TX
78539-5658
US

IV. Provider business mailing address

910 S CLOSNER BLVD
EDINBURG TX
78539-5658
US

V. Phone/Fax

Practice location:
  • Phone: 956-380-3441
  • Fax: 956-380-3715
Mailing address:
  • Phone: 956-380-3441
  • Fax: 956-380-3715

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. AGUSTIN MARTINEZ
Title or Position: PRESIDENT
Credential: MD
Phone: 956-380-3441