Healthcare Provider Details

I. General information

NPI: 1336199694
Provider Name (Legal Business Name): SERGIO GUSTAVO PRECIADO M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/10/2006
Last Update Date: 01/04/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

832 DEL ORO LN SUITE 2
PHARR TX
78577-2200
US

IV. Provider business mailing address

832 DEL ORO LN 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:
Title or Position:
Credential:
Phone: