Healthcare Provider Details

I. General information

NPI: 1144894833
Provider Name (Legal Business Name): BICENTENNIAL KIDS CLINIC PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

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

III. Provider practice location address

400 S BICENTENNIAL BLVD
MCALLEN TX
78501-5199
US

IV. Provider business mailing address

1408 E 8TH ST
WESLACO TX
78596-6639
US

V. Phone/Fax

Practice location:
  • Phone: 956-668-1060
  • Fax: 956-968-0103
Mailing address:
  • Phone: 956-968-0103
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number
License Number State

VIII. Authorized Official

Name: FELIPE M. AVILA
Title or Position: OWNER
Credential: MD
Phone: 956-968-0103