Healthcare Provider Details

I. General information

NPI: 1790912327
Provider Name (Legal Business Name): CDP ENTERPRISES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/22/2009
Last Update Date: 06/22/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

175 E ROBERTSON ST
SAN BENITO TX
78586-3859
US

IV. Provider business mailing address

175 E ROBERTSON ST
SAN BENITO TX
78586-3859
US

V. Phone/Fax

Practice location:
  • Phone: 956-399-9001
  • Fax:
Mailing address:
  • Phone: 956-399-9001
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QR0400X
TaxonomyRehabilitation Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MRS. RACHEL CALDERON
Title or Position: ADMINISTRATOR
Credential:
Phone: 956-399-9001