=====================================================
General NPI Number Information
=====================================================
NPI Number | 1235162082
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | MARISOL OZUNA
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/07/2006
-----------------------------------------------------
Last Update Date | 11/23/2010
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 923 W BUS 83 SUITE 101
-----------------------------------------------------
City | MISSION
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 78572-3668
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 956-630-0023
-----------------------------------------------------
Fax | 956-682-9246
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 923 W BUS 83 SUITE 101
-----------------------------------------------------
City | MISSION
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 78572-3668
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 956-630-0023
-----------------------------------------------------
Fax | 956-682-9246
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | ADMINISTRATOR
-----------------------------------------------------
Name | MARISOL OZUNA
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 956-630-0023
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 332B00000X
-----------------------------------------------------
Taxonomy Name | Durable Medical Equipment & Medical Supplies
-----------------------------------------------------
License Number | 0074239
-----------------------------------------------------
License Number State | TX
-----------------------------------------------------