Healthcare Provider Details

I. General information

NPI: 1770015950
Provider Name (Legal Business Name): JOSE RAFAEL CANO PENALOZA M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

Provider Other Name: JOSE RAFAEL CANO M.D.

II. Dates (important events)

Enumeration Date: 03/28/2017
Last Update Date: 12/10/2020
Certification Date: 12/10/2020
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: 956-682-0597
Mailing address:
  • Phone: 956-687-6155
  • Fax: 956-618-0451

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberS5337
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: