Healthcare Provider Details

I. General information

NPI: 1043659683
Provider Name (Legal Business Name): CIE SCREENING LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/17/2013
Last Update Date: 03/26/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

905 S JACKSON RD
PHARR TX
78577-6616
US

IV. Provider business mailing address

808 S SHARY RD SUITE 5-225
MISSION TX
78572-8568
US

V. Phone/Fax

Practice location:
  • Phone: 956-307-8378
  • Fax:
Mailing address:
  • Phone: 956-307-8378
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code246Z00000X
TaxonomyOther Specialist/Technologist
License Number
License Number State

VIII. Authorized Official

Name: CARMEN ROMAN
Title or Position: PRINCIPAL
Credential:
Phone: 956-307-8378