Healthcare Provider Details

I. General information

NPI: 1215192364
Provider Name (Legal Business Name): CARLOS G CIGARROA, M.D., P.A.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/28/2008
Last Update Date: 07/28/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

702 E CALTON RD SUITE 101
LAREDO TX
78041-3988
US

IV. Provider business mailing address

PO BOX 451428
LAREDO TX
78045-0035
US

V. Phone/Fax

Practice location:
  • Phone: 956-728-8255
  • Fax: 956-728-0400
Mailing address:
  • Phone: 956-728-8255
  • Fax: 956-728-0040

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberJ1212
License Number StateTX
# 2
Primary TaxonomyY
Taxonomy Code246W00000X
TaxonomyCardiology Technician
License NumberJ1212
License Number StateTX

VIII. Authorized Official

Name: CARLOS G CIGARROA
Title or Position: PRESIDENT
Credential: M.D.
Phone: 956-728-8255