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General NPI Number Information
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NPI Number | 1801144886
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Entity Type | Individual
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Provider Name | CLAUDIA EDITH SOBREVILLA PA-C
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Gender | Female
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Dates
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Enumeration Date | 08/22/2012
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Last Update Date | 08/22/2012
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Provider Practice Location Address
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Address Line | 605 N MAIN ST SUITE C
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City | DONNA
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State | TX
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Zip | 78537-2725
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Country | US
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Telephone | 956-460-0895
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Fax |
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Provider Business Mailing Address
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Address Line | 6817 ADAMS DR
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City | MISSION
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State | TX
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Zip | 78573-7513
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Country | US
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Telephone | 956-457-7744
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Fax |
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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 | 363AM0700X
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Taxonomy Name | Medical Physician Assistant
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License Number | PA07840
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License Number State | TX
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