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General NPI Number Information
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NPI Number | 1205597671
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Entity Type | Organization
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Legal Business Name | RECORDS REQUEST
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Dates
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Enumeration Date | 01/06/2022
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Last Update Date | 03/17/2022
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Provider Practice Location Address
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Address Line | 1200 CENTRAL BLVD STE H1
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City | BROWNSVILLE
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State | TX
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Zip | 78520-7543
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Country | US
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Telephone | 956-572-0033
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Fax |
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Provider Business Mailing Address
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Address Line | 335 PINAR DEL RIO AVE
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City | BROWNSVILLE
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State | TX
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Zip | 78526-1957
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Country | US
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Telephone | 956-572-0033
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Fax |
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Authorized Official
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Title or Position | MANAGER/OWNER
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Name | MARK CORTEZ
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Credential |
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Telephone | 956-572-0033
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261Q00000X
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Taxonomy Name | Clinic/Center
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License Number |
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License Number State | NULL
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Taxonomy #2
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Taxonomy Code | 291U00000X
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Taxonomy Name | Clinical Medical Laboratory
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License Number |
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License Number State | NULL
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