Healthcare Provider Details

I. General information

NPI: 1437349727
Provider Name (Legal Business Name): SIESTA TEXAS ANESTHESIA PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/01/2007
Last Update Date: 08/28/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1305 E NOLANA AVE SUITE H
MCALLEN TX
78504-6114
US

IV. Provider business mailing address

PO BOX 3744
MCALLEN TX
78502-3744
US

V. Phone/Fax

Practice location:
  • Phone: 956-682-4151
  • Fax: 956-682-4154
Mailing address:
  • Phone: 956-682-4151
  • Fax: 956-682-4154

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number
License Number State

VIII. Authorized Official

Name: DAVID CLARK
Title or Position: OWNER/PROVIDER
Credential:
Phone: 956-682-4151