Healthcare Provider Details

I. General information

NPI: 1114130218
Provider Name (Legal Business Name): LOWER RIO GRANDE VALLEY COMMUNITY HEALTH MANAGEMENT CORPORATION INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/07/2007
Last Update Date: 06/17/2021
Certification Date: 06/17/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

901 E VERMONT AVE
MCALLEN TX
78503-1729
US

IV. Provider business mailing address

901 E VERMONT AVE
MCALLEN TX
78503-1729
US

V. Phone/Fax

Practice location:
  • Phone: 956-213-6400
  • Fax: 956-213-0692
Mailing address:
  • Phone: 956-213-6400
  • Fax: 956-213-0692

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: MARISOL RESENDEZ
Title or Position: EXECUTIVE DIRECTOR
Credential:
Phone: 956-213-6410