=====================================================
General NPI Number Information
=====================================================
NPI Number | 1477837300
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | CANO FAMILY MEDICINE CLINIC, PLLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/11/2011
-----------------------------------------------------
Last Update Date | 10/11/2011
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 100B E ALTON GLOOR BLVD SUITE 150
-----------------------------------------------------
City | BROWNSVILLE
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 78526-3376
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 956-350-9600
-----------------------------------------------------
Fax | 956-350-8424
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 533878
-----------------------------------------------------
City | HARLINGEN
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 78553-3878
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 956-350-9600
-----------------------------------------------------
Fax | 956-350-8424
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | DR. PATRICIA CANO
-----------------------------------------------------
Credential | M.D.
-----------------------------------------------------
Telephone | 956-350-9600
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207Q00000X
-----------------------------------------------------
Taxonomy Name | Family Medicine Physician
-----------------------------------------------------
License Number | M9903
-----------------------------------------------------
License Number State | TX
-----------------------------------------------------