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General NPI Number Information
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NPI Number | 1548041767
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Entity Type | Organization
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Legal Business Name | SAN ISIDRO MEDICAL CENTER PLLC
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Dates
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Enumeration Date | 10/12/2023
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Last Update Date | 10/12/2023
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Provider Practice Location Address
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Address Line | 10414 MEDICAL LOOP UNIT F
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City | LAREDO
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State | TX
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Zip | 78045-6612
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Country | US
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Telephone | 956-462-5848
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Fax | 956-462-5866
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Provider Business Mailing Address
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Address Line | 10414 MEDICAL LOOP UNIT F
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City | LAREDO
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State | TX
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Zip | 78045-6612
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Country | US
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Telephone | 956-462-5848
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Fax | 956-462-5866
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Authorized Official
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Title or Position | AUTHORIZED OFFICIAL
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Name | JAZIEL SILVA-GONZALEZ
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Credential | AUDIOLOGIST
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Telephone | 956-462-5848
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207QG0300X
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Taxonomy Name | Geriatric Medicine (Family Medicine) Physician
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 133NN1002X
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Taxonomy Name | Nutrition Education Nutritionist
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License Number |
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Taxonomy #3
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Taxonomy Code | 261QP2000X
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Taxonomy Name | Physical Therapy Clinic/Center
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number |
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License Number State |
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Taxonomy #5
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Taxonomy Code | 261QM1300X
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Taxonomy Name | Multi-Specialty Clinic/Center
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License Number |
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