Healthcare Provider Details

I. General information

NPI: 1376369355
Provider Name (Legal Business Name): JOSE ARMANDO BARRERA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/25/2024
Last Update Date: 11/25/2024
Certification Date: 11/25/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3502 W ALBERTA RD
EDINBURG TX
78539-8466
US

IV. Provider business mailing address

118 IVY LN
RIO GRANDE CITY TX
78582-6600
US

V. Phone/Fax

Practice location:
  • Phone: 956-803-0120
  • Fax:
Mailing address:
  • Phone: 956-844-0549
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number1180358
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: