Healthcare Provider Details

I. General information

NPI: 1558073239
Provider Name (Legal Business Name): SANDRA MASSO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/14/2022
Last Update Date: 09/23/2026
Certification Date: 09/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1613 N INTERNATIONAL BLVD
WESLACO TX
78599-0268
US

IV. Provider business mailing address

1609 N INTERNATIONAL BLVD
WESLACO TX
78599-0285
US

V. Phone/Fax

Practice location:
  • Phone: 956-405-3690
  • Fax: 956-405-3691
Mailing address:
  • Phone: 956-405-3690
  • Fax: 956-405-3691

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: