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General NPI Number Information
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NPI Number | 1265993042
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Entity Type | Organization
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Legal Business Name | RESTORE WELLNESS RGV PLLC
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Dates
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Enumeration Date | 03/26/2019
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Last Update Date | 03/26/2019
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Provider Practice Location Address
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Address Line | 725 E ESPERANZA AVE STE B
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City | MCALLEN
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State | TX
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Zip | 78501-1402
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Country | US
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Telephone | 956-683-6797
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Fax |
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Provider Business Mailing Address
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Address Line | 1416 WALNUT AVE
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City | MCALLEN
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State | TX
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Zip | 78501-4239
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Country | US
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Telephone | 509-930-2519
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | MR. STEPHEN MARTINEZ JR.
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Credential | P.A.
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Telephone | 509-930-2519
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QP2300X
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Taxonomy Name | Primary Care Clinic/Center
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License Number |
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License Number State |
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