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General NPI Number Information
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NPI Number | 1669855870
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Entity Type | Organization
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Legal Business Name | ISAAC ORNELAS
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Dates
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Enumeration Date | 07/07/2015
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Last Update Date | 07/07/2015
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Provider Practice Location Address
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Address Line | 3302 BOCA CHICA BLVD
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City | BROWNSVILLE
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State | TX
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Zip | 78521-5193
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Country | US
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Telephone | 956-982-1001
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Fax | 956-544-4741
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Provider Business Mailing Address
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Address Line | PO BOX 1029
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City | OLMITO
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State | TX
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Zip | 78575-1029
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Country | US
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Telephone | 956-982-1001
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Fax | 956-544-4741
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Authorized Official
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Title or Position | CREDENTIALING COORDINATOR
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Name | MRS. VERONICA GARCIA
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Credential |
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Telephone | 956-982-1001
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | 1232455
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License Number State | TX
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