Healthcare Provider Details

I. General information

NPI: 1275181455
Provider Name (Legal Business Name): RENAISSANCE RADIOLOGY ASSOCIATES PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/30/2019
Last Update Date: 10/22/2023
Certification Date: 10/22/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5501 S MCCOLL RD
EDINBURG TX
78539-5503
US

IV. Provider business mailing address

5501 S MCCOLL RD
EDINBURG TX
78539-5503
US

V. Phone/Fax

Practice location:
  • Phone: 956-661-7100
  • Fax:
Mailing address:
  • Phone: 956-362-7553
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number
License Number State

VIII. Authorized Official

Name: RODOLFO LUIS GARCIA
Title or Position: PRESIDENT/SECRETARY
Credential: MD
Phone: 956-362-7553