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General NPI Number Information
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NPI Number | 1649838178
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Entity Type | Organization
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Legal Business Name | CHARLES MEDICAL MANAGEMENT SERVICES, LLC
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Dates
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Enumeration Date | 05/30/2019
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Last Update Date | 06/13/2019
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Provider Practice Location Address
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Address Line | 723 E. UNIVERSITY
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City | EDINBURG
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State | TX
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Zip | 78539
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Country | US
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Telephone | 956-205-0103
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Fax | 956-720-4461
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Provider Business Mailing Address
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Address Line | 2112 W. UNIVERSITY DR. #356
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City | EDINBURG
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State | TX
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Zip | 78539
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Country | US
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Telephone | 956-205-0103
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Fax | 956-720-4461
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Authorized Official
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Title or Position | PRESIDENT
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Name | MR. DAN VELAZQUEZ
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Credential |
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Telephone | 956-205-0103
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 291U00000X
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Taxonomy Name | Clinical Medical Laboratory
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License Number |
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License Number State |
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