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General NPI Number Information
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NPI Number | 1124751896
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Entity Type | Organization
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Legal Business Name | PROFESSIONAL PSYCHIATRIC ASSOCIATES OF RGV, PLLC
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Dates
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Enumeration Date | 07/08/2022
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Last Update Date | 10/17/2022
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Provider Practice Location Address
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Address Line | 104 NORTH SALINAS BLVD SUITE-A
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City | DONNA
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State | TX
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Zip | 78537
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Country | US
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Telephone | 956-377-5400
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Fax | 956-377-5509
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Provider Business Mailing Address
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Address Line | 104 NORTH SALINAS BLVD SUITE -A
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City | DONNA
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State | TX
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Zip | 78537
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Country | US
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Telephone | 956-377-5710
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Fax | 956-377-5509
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Authorized Official
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Title or Position | OWNER
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Name | MICHAEL A FLORES
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Credential | MD
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Telephone | 956-377-5400
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 261QM0801X
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Taxonomy Name | Mental Health Clinic/Center (Including Community Mental Health Center)
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License Number |
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License Number State |
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