Healthcare Provider Details

I. General information

NPI: 1902827108
Provider Name (Legal Business Name): CITY OF PORT ISABEL
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/22/2006
Last Update Date: 03/06/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

110 W HICKMAN AVE
PORT ISABEL TX
78578-2906
US

IV. Provider business mailing address

110 W HICKMAN AVE
PORT ISABEL TX
78578-2906
US

V. Phone/Fax

Practice location:
  • Phone: 956-943-2682
  • Fax: 956-943-2029
Mailing address:
  • Phone: 956-943-2682
  • Fax: 956-943-2029

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3416L0300X
TaxonomyLand Ambulance
License Number031004
License Number StateTX

VIII. Authorized Official

Name: PETE CAPISTRAN
Title or Position: FINANCE DIRECTOR
Credential:
Phone: 956-943-2682