Healthcare Provider Details

I. General information

NPI: 1558589853
Provider Name (Legal Business Name): RGV FOOTCARE PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/23/2007
Last Update Date: 06/25/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1401 E RIDGE RD SUITE E
MCALLEN TX
78503-1524
US

IV. Provider business mailing address

1401 E RIDGE RD SUITE E
MCALLEN TX
78503-1524
US

V. Phone/Fax

Practice location:
  • Phone: 956-618-2970
  • Fax: 956-618-2398
Mailing address:
  • Phone: 956-618-2970
  • Fax: 956-618-2398

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213EP1101X
TaxonomyPrimary Podiatric Medicine Podiatrist
License Number1263
License Number StateTX

VIII. Authorized Official

Name: DR. GUADALUPE JAVIER CAVAZOS JR.
Title or Position: OWNER
Credential: D.P.M.
Phone: 956-618-2970