=====================================================
General NPI Number Information
=====================================================
NPI Number | 1407654775
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | OCCUPATIONAL EXPRESS PLUS
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/04/2025
-----------------------------------------------------
Last Update Date | 03/04/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 585 W JEFFERSON ST
-----------------------------------------------------
City | BROWNSVILLE
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 78520-6333
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 956-504-7245
-----------------------------------------------------
Fax | 956-554-9939
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 585 W JEFFERSON ST
-----------------------------------------------------
City | BROWNSVILLE
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 78520-6333
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 956-504-7245
-----------------------------------------------------
Fax | 956-554-9939
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | BENITO GONZALEZ III
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 956-504-7245
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207Q00000X
-----------------------------------------------------
Taxonomy Name | Family Medicine Physician
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State | NULL
-----------------------------------------------------