Healthcare Provider Details

I. General information

NPI: 1649666991
Provider Name (Legal Business Name): RGV WELLNESS CENTER LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/14/2015
Last Update Date: 04/14/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

512 VICTORIA LN STE 2
HARLINGEN TX
78550-3227
US

IV. Provider business mailing address

512 VICTORIA LN STE 2
HARLINGEN TX
78550-3227
US

V. Phone/Fax

Practice location:
  • Phone: 956-365-4400
  • Fax: 956-365-4111
Mailing address:
  • Phone: 956-365-4400
  • Fax: 956-365-4111

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number
License Number StateTN
# 2
Primary TaxonomyY
Taxonomy Code207RG0100X
TaxonomyGastroenterology Physician
License Number
License Number StateTX

VIII. Authorized Official

Name: NOLAN E PEREZ
Title or Position: CEO/PRESIDENT
Credential: M.D.
Phone: 956-365-4400