Healthcare Provider Details

I. General information

NPI: 1891969358
Provider Name (Legal Business Name): JOSE L BERLIOZ MD PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/16/2008
Last Update Date: 10/24/2023
Certification Date: 05/25/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10710 MCPHERSON RD SUITE 101
LAREDO TX
78045-6363
US

IV. Provider business mailing address

10710 MCPHERSON RD SUITE 101
LAREDO TX
78045-6363
US

V. Phone/Fax

Practice location:
  • Phone: 956-724-7145
  • Fax: 956-724-4944
Mailing address:
  • Phone: 956-724-7145
  • Fax: 956-724-4865

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number
License Number State

VIII. Authorized Official

Name: MRS. MARY KAFATI
Title or Position: GENERAL MANAGER
Credential:
Phone: 956-763-6335