=====================================================
General NPI Number Information
=====================================================
NPI Number | 1659142172
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | RGV DIRECT CARE PLLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/12/2024
-----------------------------------------------------
Last Update Date | 01/12/2024
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 309 W PIKE BLVD STE C
-----------------------------------------------------
City | WESLACO
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 78596-4723
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 956-581-8777
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 309 W PIKE BLVD STE C
-----------------------------------------------------
City | WESLACO
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 78596-4723
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 956-581-8777
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | CEO
-----------------------------------------------------
Name | FAUSTO ESCOBEDO
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 956-752-8341
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207Q00000X
-----------------------------------------------------
Taxonomy Name | Family Medicine Physician
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------