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General NPI Number Information
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NPI Number | 1194591198
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Entity Type | Organization
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Legal Business Name | FRONTIER DIRECT CARE WESLACO
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Dates
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Enumeration Date | 11/30/2023
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Last Update Date | 11/30/2023
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Provider Practice Location Address
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Address Line | 555 S INTERNATIONAL BLVD STE B100
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City | WESLACO
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State | TX
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Zip | 78596-9116
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Country | US
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Telephone | 956-303-6548
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Fax | 956-253-4981
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Provider Business Mailing Address
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Address Line | 119 W VAN BUREN AVE STE 2
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City | HARLINGEN
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State | TX
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Zip | 78550-6400
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Country | US
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Telephone | 956-983-9272
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Fax | 956-265-1284
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Authorized Official
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Title or Position | CHIEF MEDICAL OFFICER
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Name | DR. PETER LAZZOPINA
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Credential | MD
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Telephone | 302-545-5224
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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 |
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License Number State |
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