Healthcare Provider Details

I. General information

NPI: 1891899084
Provider Name (Legal Business Name): CARLOS G CIGARROA MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/11/2006
Last Update Date: 12/19/2011
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: 956-728-0400

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: