Healthcare Provider Details

I. General information

NPI: 1558772905
Provider Name (Legal Business Name): MY OWN HOSPICE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/19/2014
Last Update Date: 01/30/2024
Certification Date: 01/30/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8207 CALLAGHAN RD STE 400A
SAN ANTONIO TX
78230-4735
US

IV. Provider business mailing address

6900 SW 80TH ST
MIAMI FL
33143-4931
US

V. Phone/Fax

Practice location:
  • Phone: 210-988-1461
  • Fax: 210-404-9887
Mailing address:
  • Phone: 305-591-1606
  • Fax: 305-591-1618

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RH0002X
TaxonomyHospice and Palliative Medicine (Internal Medicine) Physician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code251G00000X
TaxonomyCommunity Based Hospice Care Agency
License Number018026
License Number StateTX

VIII. Authorized Official

Name: ISMAEL ROQUE-VELASCO
Title or Position: PRESIDENT AND CEO
Credential:
Phone: 305-591-1606