Healthcare Provider Details

I. General information

NPI: 1952145864
Provider Name (Legal Business Name): SYB LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/24/2024
Last Update Date: 08/13/2024
Certification Date: 08/13/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1910 S 1ST ST STE 400
MCALLEN TX
78503-1255
US

IV. Provider business mailing address

1910 S 1ST ST STE 400
MCALLEN TX
78503-1255
US

V. Phone/Fax

Practice location:
  • Phone: 956-346-2152
  • Fax:
Mailing address:
  • Phone: 956-346-2152
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213E00000X
TaxonomyPodiatrist
License Number
License Number State

VIII. Authorized Official

Name: SANDRA Y BLANCO
Title or Position: PRESIDENT
Credential:
Phone: 956-346-2152