Healthcare Provider Details

I. General information

NPI: 1821374166
Provider Name (Legal Business Name): HECTOR E BANDA-GUTIERREZ OTR
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/01/2011
Last Update Date: 09/01/2026
Certification Date: 09/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4105 N ROSE DR
PHARR TX
78577-7612
US

IV. Provider business mailing address

4105 N ROSE DR
PHARR TX
78577-7612
US

V. Phone/Fax

Practice location:
  • Phone: 956-483-3155
  • Fax:
Mailing address:
  • Phone: 956-483-3155
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number210638
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: