Healthcare Provider Details

I. General information

NPI: 1316633340
Provider Name (Legal Business Name): LAURA RIVERO FERNANDEZ DE ALAIZA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/13/2023
Last Update Date: 04/13/2023
Certification Date: 04/13/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

205 E TORONTO AVE
MCALLEN TX
78503-1209
US

IV. Provider business mailing address

541 FM 1488 RD APT 224
CONROE TX
77384-6003
US

V. Phone/Fax

Practice location:
  • Phone: 956-687-6155
  • Fax:
Mailing address:
  • Phone: 786-277-3448
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: