Healthcare Provider Details

I. General information

NPI: 1770683195
Provider Name (Legal Business Name): UROLOGY ASSOCIATES OF SOUTH TEXAS PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/25/2006
Last Update Date: 01/13/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

110 E SAVANNAH SUITE C-101
MCALLEN TX
78503-1241
US

IV. Provider business mailing address

PO BOX 34776
SAN ANTONIO TX
78265-4776
US

V. Phone/Fax

Practice location:
  • Phone: 956-686-8357
  • Fax: 956-686-5030
Mailing address:
  • Phone: 956-686-8357
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208800000X
TaxonomyUrology Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. CARLOS P DE JUANA
Title or Position: UROLOGIST/PARTNER
Credential: M.D.
Phone: 956-686-8357