Healthcare Provider Details

I. General information

NPI: 1316460975
Provider Name (Legal Business Name): REBOUND H2O, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/25/2017
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5464 NUTMEG TRL
LEON VALLEY TX
78238-2324
US

IV. Provider business mailing address

5464 NUTMEG TRL
LEON VALLEY TX
78238-2324
US

V. Phone/Fax

Practice location:
  • Phone: 210-778-9911
  • Fax: 877-900-7372
Mailing address:
  • Phone: 210-778-9911
  • Fax: 877-900-7372

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251F00000X
TaxonomyHome Infusion Agency
License Number
License Number State

VIII. Authorized Official

Name: MR. RAUL A CORREA
Title or Position: PARTNER/CIFO
Credential: RN
Phone: 210-778-9911