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General NPI Number Information
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NPI Number | 1588028724
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Entity Type | Individual
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Provider Name | MARIELA ONTIVEROS
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Gender | Female
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Dates
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Enumeration Date | 04/13/2016
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Last Update Date | 04/26/2016
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Provider Practice Location Address
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Address Line | 4709 S JACKSON RD
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City | EDINBURG
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State | TX
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Zip | 78539-8381
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Country | US
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Telephone | 956-682-4500
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Fax | 956-682-4505
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Provider Business Mailing Address
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Address Line | 1016 LEE ST
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City | MISSION
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State | TX
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Zip | 78572-3430
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Country | US
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Telephone | 956-310-2298
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Fax |
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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 | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | PA10494
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License Number State | TX
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