Healthcare Provider Details

I. General information

NPI: 1205067964
Provider Name (Legal Business Name): RODOLFO A QUINTANA PSYD PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/29/2009
Last Update Date: 09/30/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1801 S 5TH ST STE 122
MCALLEN TX
78503-2919
US

IV. Provider business mailing address

PO BOX 5622
MCALLEN TX
78502-5622
US

V. Phone/Fax

Practice location:
  • Phone: 956-630-9454
  • Fax: 956-630-9447
Mailing address:
  • Phone: 956-630-9454
  • Fax: 956-630-9447

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number32103
License Number StateTX

VIII. Authorized Official

Name: DR. RODOLFO A QUINTANA
Title or Position: OWNER
Credential: PSY.D.
Phone: 956-630-9454