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General NPI Number Information
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NPI Number | 1528003936
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Entity Type | Individual
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Provider Name | MARIO RUDY ANZALDUA M.D.
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Gender | Male
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Dates
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Enumeration Date | 06/19/2006
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Last Update Date | 10/19/2022
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Provider Practice Location Address
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Address Line | 1512 E GRIFFIN PKWY STE 2
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City | MISSION
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State | TX
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Zip | 78572-2422
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Country | US
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Telephone | 956-519-7088
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Fax | 956-519-9816
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Provider Business Mailing Address
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Address Line | 1512 E GRIFFIN PKWY STE 2
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City | MISSION
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State | TX
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Zip | 78572-2422
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Country | US
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Telephone | 956-519-7088
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Fax | 956-519-9816
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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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 | F9142
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License Number State | TX
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