Healthcare Provider Details

I. General information

NPI: 1720993355
Provider Name (Legal Business Name): MARIELA MONIQUE BERRONES
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/18/2026
Last Update Date: 08/18/2026
Certification Date: 08/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6010 W EXPRESSWAY 83
PALMVIEW TX
78572
US

IV. Provider business mailing address

6010 W EXPRESSWAY 83
PALMVIEW TX
78572
US

V. Phone/Fax

Practice location:
  • Phone: 956-585-3959
  • Fax:
Mailing address:
  • Phone: 956-585-3959
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number77631
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: