Healthcare Provider Details

I. General information

NPI: 1699304501
Provider Name (Legal Business Name): ILIANA MEAGAN CHAPA MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/02/2020
Last Update Date: 06/29/2023
Certification Date: 06/29/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4115 PECAN BLVD STE B
MCALLEN TX
78501-3695
US

IV. Provider business mailing address

4115 PECAN BLVD STE B
MCALLEN TX
78501-3695
US

V. Phone/Fax

Practice location:
  • Phone: 956-686-6050
  • Fax:
Mailing address:
  • Phone: 956-686-6050
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateTX
# 2
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberU2172
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: