Healthcare Provider Details

I. General information

NPI: 1710330444
Provider Name (Legal Business Name): TEXAS CENTER FOR NEUROPSYCHOLOGY, P.A.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/18/2016
Last Update Date: 07/18/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2503 BUDDY OWENS AVE
MCALLEN TX
78504-5427
US

IV. Provider business mailing address

2503 BUDDY OWENS AVE
MCALLEN TX
78504-5427
US

V. Phone/Fax

Practice location:
  • Phone: 956-631-6109
  • Fax: 956-631-6125
Mailing address:
  • Phone: 956-631-6109
  • Fax: 956-631-6125

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103G00000X
TaxonomyClinical Neuropsychologist
License Number36112
License Number StateTX
# 2
Primary TaxonomyN
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number36112
License Number StateTX

VIII. Authorized Official

Name: GABRIEL A. JASSO
Title or Position: OWNER
Credential: M.D.
Phone: 956-631-0225