Healthcare Provider Details

I. General information

NPI: 1235354507
Provider Name (Legal Business Name): SERGIO G. PRECIADO, M.D., P.A.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/13/2007
Last Update Date: 09/29/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

832 DEL ORO SUITE 2
PHARR TX
78577-2200
US

IV. Provider business mailing address

832 DEL ORO SUITE 2
PHARR TX
78577-2200
US

V. Phone/Fax

Practice location:
  • Phone: 956-787-2500
  • Fax: 956-787-2528
Mailing address:
  • Phone: 956-787-2500
  • Fax: 956-787-2528

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberJ9278
License Number StateTX

VIII. Authorized Official

Name: SERGIO G. PRECIADO
Title or Position: OWNER
Credential: M.D.
Phone: 956-787-2500