Healthcare Provider Details

I. General information

NPI: 1215112131
Provider Name (Legal Business Name): RGV PEDIATRIC CRITICAL CARE PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/09/2008
Last Update Date: 09/10/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

102 N NUECES PARK LN
HARLINGEN TX
78552-6235
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 TaxonomyY
Taxonomy Code2080P0203X
TaxonomyPediatric Critical Care Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. MARIA TERESA CAMACHO
Title or Position: PRESIDENT
Credential: M.D.
Phone: 956-245-6560