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General NPI Number Information
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NPI Number | 1184023335
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Entity Type | Organization
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Legal Business Name | LIZA COLCHADO
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Dates
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Enumeration Date | 08/13/2014
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Last Update Date | 11/24/2014
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Provider Practice Location Address
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Address Line | 4210 VIDA GRANDE
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City | WESLACO
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State | TX
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Zip | 78596-8635
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Country | US
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Telephone | 956-650-0188
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Fax |
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Provider Business Mailing Address
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Address Line | 4210 VIDA GRANDE
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City | WESLACO
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State | TX
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Zip | 78596-8635
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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 | LIZA COLCHADO
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Credential |
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Telephone | 956-650-0188
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 335V00000X
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Taxonomy Name | Portable X-ray and/or Other Portable Diagnostic Imaging Supplier
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License Number |
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License Number State |
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