Healthcare Provider Details

I. General information

NPI: 1699475913
Provider Name (Legal Business Name): OPTIMUM WOMENS HEALTH RIO GRANDE VALLEY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/06/2023
Last Update Date: 06/19/2023
Certification Date: 05/13/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1106 W SAM HOUSTON BLVD STE 2
PHARR TX
78577-5104
US

IV. Provider business mailing address

1106 W SAM HOUSTON BLVD
PHARR TX
78577-5104
US

V. Phone/Fax

Practice location:
  • Phone: 956-467-4226
  • Fax: 956-467-2229
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: MR. ROGELIO FLORES
Title or Position: OWNER
Credential: FNP
Phone: 956-467-2226