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General NPI Number Information
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NPI Number | 1184817736
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Entity Type | Organization
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Legal Business Name | MCALLEN PRIMARY CARE CLINIC
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Dates
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Enumeration Date | 08/27/2007
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Last Update Date | 02/04/2010
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Provider Practice Location Address
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Address Line | 110 E SAVANNAH AVE BLDG A204
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City | MCALLEN
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State | TX
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Zip | 78503-1239
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Country | US
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Telephone | 956-686-4040
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Fax | 956-686-2936
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Provider Business Mailing Address
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Address Line | 110 E SAVANNAH AVE BLDG A204
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City | MCALLEN
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State | TX
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Zip | 78503-1239
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Country | US
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Telephone | 956-686-4040
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Fax | 956-686-2936
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Authorized Official
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Title or Position | ADMINISTRATOR
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Name | DESAUSSURE TREVINO
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Credential | RN
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Telephone | 956-686-4040
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | C4798
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License Number State | TX
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