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General NPI Number Information
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NPI Number | 1356396139
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Entity Type | Organization
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Legal Business Name | ALTBA,P.A.
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Dates
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Enumeration Date | 05/23/2006
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Last Update Date | 10/08/2009
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Provider Practice Location Address
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Address Line | 1821 SESAME DRIVE SUITE#8
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City | HARLINGEN
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State | TX
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Zip | 78550
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Country | US
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Telephone | 956-425-6500
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Fax | 956-425-6501
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Provider Business Mailing Address
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Address Line | 1821 SESAME DRIVE SUITE#8
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City | HARLINGEN
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State | TX
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Zip | 78550
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Country | US
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Telephone | 956-425-6500
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Fax | 956-425-6501
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Authorized Official
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Title or Position | PHYSICIAN OWNER
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Name | LUIS ALFREDO GONZALEZ
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Credential | M.D.
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Telephone | 956-425-6500
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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 | L0213
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License Number State | TX
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