=====================================================
General NPI Number Information
=====================================================
NPI Number | 1487754438
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | SAN BENITO IMAGING CENTER LP
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/22/2006
-----------------------------------------------------
Last Update Date | 01/06/2026
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 200 N SAM HOUSTON BLVD
-----------------------------------------------------
City | SAN BENITO
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 78586-4655
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 956-399-2666
-----------------------------------------------------
Fax | 956-399-2638
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 200 N SAM HOUSTON BLVD
-----------------------------------------------------
City | SAN BENITO
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 78586-4655
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 956-399-2666
-----------------------------------------------------
Fax | 956-399-2638
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | FACILITY DIRECTOR
-----------------------------------------------------
Name | MR. RUDY RIVAS
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 956-399-2666
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 2085U0001X
-----------------------------------------------------
Taxonomy Name | Diagnostic Ultrasound Physician
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 2085R0202X
-----------------------------------------------------
Taxonomy Name | Diagnostic Radiology Physician
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------