=====================================================
General NPI Number Information
=====================================================
NPI Number | 1437330263
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | LAREDO CARDIOLOGY CENTER
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 11/20/2007
-----------------------------------------------------
Last Update Date | 04/20/2008
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 10710 MCPHERSON RD STE 105
-----------------------------------------------------
City | LAREDO
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 78045-6363
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 956-717-2328
-----------------------------------------------------
Fax | 956-717-2395
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 10710 MCPHERSON RD STE 105
-----------------------------------------------------
City | LAREDO
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 78045-6363
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 956-717-2328
-----------------------------------------------------
Fax | 956-717-2395
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PHYSICIAN
-----------------------------------------------------
Name | EDWIN R. MARTINEZ
-----------------------------------------------------
Credential | MD
-----------------------------------------------------
Telephone | 956-717-2328
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207RC0000X
-----------------------------------------------------
Taxonomy Name | Cardiovascular Disease Physician
-----------------------------------------------------
License Number | L3390
-----------------------------------------------------
License Number State | TX
-----------------------------------------------------