Healthcare Provider Details

I. General information

NPI: 1629479787
Provider Name (Legal Business Name): ROBERTO URESTI
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/09/2014
Last Update Date: 09/09/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1505 CALLE DEL NORTE SUITE 440
LAREDO TX
78041-6036
US

IV. Provider business mailing address

305 NE LOOP 820 BUSINESS TOWER1, SUITE 200
HURST TX
76053-7209
US

V. Phone/Fax

Practice location:
  • Phone: 956-722-6221
  • Fax: 956-722-6275
Mailing address:
  • Phone: 817-292-8787
  • Fax: 817-789-6849

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License Number2105706
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: