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General NPI Number Information
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NPI Number | 1164688925
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Entity Type | Organization
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Legal Business Name | RENAISSANCE OUTPATIENT REHABILITATION CENTER, LLC
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Dates
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Enumeration Date | 07/31/2008
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Last Update Date | 07/31/2008
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Provider Practice Location Address
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Address Line | 2010 E GRIFFIN PKWY
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City | MISSION
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State | TX
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Zip | 78572-3223
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Country | US
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Telephone | 956-583-2600
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Fax | 956-583-8580
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Provider Business Mailing Address
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Address Line | 2010 E GRIFFIN PKWY
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City | MISSION
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State | TX
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Zip | 78572-3223
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Country | US
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Telephone | 956-583-2600
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Fax | 956-583-8580
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Authorized Official
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Title or Position | SPEECH LANGUAGE PATHOLOGIST
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Name | MRS. IMEDA CASTILLO
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Credential | MS,CCC-SLP
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Telephone | 956-586-2600
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 231H00000X
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Taxonomy Name | Audiologist
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License Number | 103816
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License Number State | TX
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