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General NPI Number Information
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NPI Number | 1235363433
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Entity Type | Individual
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Provider Name | JOSE RICARDO SOBREVILLA MD
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Gender | Male
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Dates
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Enumeration Date | 05/04/2009
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Last Update Date | 04/26/2019
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Provider Practice Location Address
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Address Line | 4302 S SUGAR RD STE 101
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City | EDINBURG
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State | TX
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Zip | 78539-9140
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Country | US
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Telephone | 956-388-2700
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Fax | 956-388-2710
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Provider Business Mailing Address
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Address Line | 4302 S SUGAR RD STE 101
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City | EDINBURG
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State | TX
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Zip | 78539-9140
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Country | US
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Telephone | 956-388-2700
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Fax | 956-388-2710
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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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 | P2066
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License Number State | TX
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Taxonomy #2
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Taxonomy Code | 208M00000X
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Taxonomy Name | Hospitalist Physician
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License Number | P2066
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License Number State | TX
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Taxonomy #3
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Taxonomy Code | 2083P0011X
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Taxonomy Name | Undersea and Hyperbaric Medicine (Preventive Medicine) Physician
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License Number | P2066
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License Number State | TX
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