Healthcare Provider Details

I. General information

NPI: 1477698942
Provider Name (Legal Business Name): MEDICAL TRAUMA SPECIALIST
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/21/2007
Last Update Date: 05/29/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1708 N CAGE BLVD
PHARR TX
78577-2528
US

IV. Provider business mailing address

PO BOX 4582
MCALLEN TX
78502-4582
US

V. Phone/Fax

Practice location:
  • Phone: 956-668-9800
  • Fax: 956-668-8438
Mailing address:
  • Phone: 956-668-9800
  • Fax: 956-668-8438

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3416L0300X
TaxonomyLand Ambulance
License Number300221
License Number StateTX

VIII. Authorized Official

Name: DAN DIAZ
Title or Position: DIRECTOR
Credential:
Phone: 956-668-9800