=====================================================
General NPI Number Information
=====================================================
NPI Number | 1699803304
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | USEDA AND ASSOCIATES
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/02/2007
-----------------------------------------------------
Last Update Date | 08/22/2020
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 101 E RIDGE RD
-----------------------------------------------------
City | MCALLEN
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 78503-1248
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 956-632-6405
-----------------------------------------------------
Fax | 956-994-8761
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 222 E RIDGE RD STE. 108
-----------------------------------------------------
City | MCALLEN
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 78503-1251
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 965-687-7806
-----------------------------------------------------
Fax | 956-994-8761
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | DR. DOMINGO H USEDA
-----------------------------------------------------
Credential | M.D.
-----------------------------------------------------
Telephone | 956-630-3662
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207ZP0102X
-----------------------------------------------------
Taxonomy Name | Anatomic Pathology & Clinical Pathology Physician
-----------------------------------------------------
License Number | C6541
-----------------------------------------------------
License Number State | TX
-----------------------------------------------------