Healthcare Provider Details

I. General information

NPI: 1316575566
Provider Name (Legal Business Name): JUAN DE LA CRUZ RODRIGUEZ NUNEZ
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/31/2020
Last Update Date: 11/07/2024
Certification Date: 11/07/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

205 E TORONTO AVE
MCALLEN TX
78503-1209
US

IV. Provider business mailing address

205 E TORONTO AVE
MCALLEN TX
78503-1209
US

V. Phone/Fax

Practice location:
  • Phone: 956-687-6155
  • Fax:
Mailing address:
  • Phone: 956-687-6155
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberMD2022-1425
License Number StateNM
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License NumberU6064
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: