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General NPI Number Information
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NPI Number | 1750364659
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Entity Type | Individual
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Provider Name | FRUCTUOSO R IRIGOYEN MD
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Gender | Male
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Dates
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Enumeration Date | 11/23/2005
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Last Update Date | 02/06/2013
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Provider Practice Location Address
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Address Line | 2116 E GRIFFIN PKWY SUITE A
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City | MISSION
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State | TX
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Zip | 78572-3295
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Country | US
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Telephone | 956-581-0355
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Fax | 956-581-0363
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Provider Business Mailing Address
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Address Line | PO BOX 1599
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City | MCALLEN
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State | TX
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Zip | 78505-1599
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Country | US
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Telephone | 956-627-3738
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Fax | 956-627-1465
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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 | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number | G2153
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License Number State | TX
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