Healthcare Provider Details

I. General information

NPI: 1164055166
Provider Name (Legal Business Name): RGV SURGICAL ASSOCIATES, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/18/2020
Last Update Date: 02/18/2020
Certification Date: 02/18/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

910 S BRYAN RD STE 202
MISSION TX
78572-6659
US

IV. Provider business mailing address

910 S BRYAN RD STE 202
MISSION TX
78572-6659
US

V. Phone/Fax

Practice location:
  • Phone: 956-682-6126
  • Fax: 956-580-0464
Mailing address:
  • Phone: 956-682-6126
  • Fax: 956-580-0464

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number
License Number State

VIII. Authorized Official

Name: MRS. MARICELA CASTILLO
Title or Position: OFFICE MANAGER
Credential:
Phone: 956-682-6126