Healthcare Provider Details

I. General information

NPI: 1083150924
Provider Name (Legal Business Name): ANTHONY REGINALD J CAUBA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/17/2017
Last Update Date: 05/03/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

416 LINDBERG AVE SUITE A
MCALLEN TX
78501-2922
US

IV. Provider business mailing address

3009 VIOLET AVE
MCALLEN TX
78504-5292
US

V. Phone/Fax

Practice location:
  • Phone: 956-630-4161
  • Fax: 956-664-7989
Mailing address:
  • Phone: 956-627-6354
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberAP132613
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: