Healthcare Provider Details

I. General information

NPI: 1730636606
Provider Name (Legal Business Name): RGV PEDIATRIC SPECIAL CARE PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/07/2016
Last Update Date: 01/23/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4302 S SUGAR RD STE 205
EDINBURG TX
78539-7073
US

IV. Provider business mailing address

PO BOX 534358
HARLINGEN TX
78553-4358
US

V. Phone/Fax

Practice location:
  • Phone: 956-421-2414
  • Fax: 956-421-3321
Mailing address:
  • Phone: 956-421-2414
  • Fax: 956-421-3321

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2080P0203X
TaxonomyPediatric Critical Care Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number
License Number State

VIII. Authorized Official

Name: MARIA CAMACHO
Title or Position: DIRECTOR
Credential: MD
Phone: 956-421-2414