=====================================================
General NPI Number Information
=====================================================
NPI Number | 1346348471
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | RICHARD ANGUIANO M.D.
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/20/2006
-----------------------------------------------------
Last Update Date | 10/18/2017
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1310 JUNCTION DR STE A
-----------------------------------------------------
City | LAREDO
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 78041-6512
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 956-333-3008
-----------------------------------------------------
Fax | 210-314-4949
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 1668
-----------------------------------------------------
City | HELOTES
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 78023-1668
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 956-333-3008
-----------------------------------------------------
Fax | 210-314-4949
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 2085R0202X
-----------------------------------------------------
Taxonomy Name | Diagnostic Radiology Physician
-----------------------------------------------------
License Number | K2402
-----------------------------------------------------
License Number State | TX
-----------------------------------------------------