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General NPI Number Information
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NPI Number | 1003126426
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Entity Type | Organization
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Legal Business Name | RIO GRANDE EAR NOSE & THROAT SPECIALISTS PA
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Dates
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Enumeration Date | 10/19/2010
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Last Update Date | 10/05/2011
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Provider Practice Location Address
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Address Line | 1901 N ED CAREY DR STE 200
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City | HARLINGEN
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State | TX
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Zip | 78550-8255
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Country | US
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Telephone | 956-425-9090
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Fax | 956-425-9092
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Provider Business Mailing Address
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Address Line | PO BOX 1089
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City | OLMITO
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State | TX
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Zip | 78575-1089
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | TAN NGUYEN
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Credential |
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Telephone | 956-425-9090
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Y00000X
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Taxonomy Name | Otolaryngology Physician
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License Number | L0455
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License Number State | TX
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