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General NPI Number Information
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NPI Number | 1215002415
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Entity Type | Organization
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Legal Business Name | LAREDO OBGYN ASSOCIATES P.A.
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Dates
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Enumeration Date | 11/22/2006
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Last Update Date | 06/02/2009
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Provider Practice Location Address
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Address Line | 1710 E SAUNDERS ST STE. B485
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City | LAREDO
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State | TX
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Zip | 78041-5443
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Country | US
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Telephone | 956-791-2229
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Fax | 956-791-1280
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Provider Business Mailing Address
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Address Line | 1710 E SAUNDERS ST STE. B485
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City | LAREDO
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State | TX
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Zip | 78041-5443
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Country | US
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Telephone | 956-791-2229
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Fax | 956-791-1280
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. RAFAEL EMILIO DEAYALA
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Credential | M.D.
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Telephone | 956-791-2229
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207V00000X
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Taxonomy Name | Obstetrics & Gynecology Physician
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License Number | H1948
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License Number State | TX
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