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General NPI Number Information
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NPI Number | 1841277118
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Entity Type | Organization
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Legal Business Name | 1810 BLDG., LTD.
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Dates
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Enumeration Date | 12/28/2005
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Last Update Date | 06/17/2008
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Provider Practice Location Address
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Address Line | 1810 E 8TH ST
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City | WESLACO
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State | TX
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Zip | 78596-6648
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Country | US
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Telephone | 956-968-9392
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Fax | 956-968-5722
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Provider Business Mailing Address
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Address Line | 1810 E 8TH ST
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City | WESLACO
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State | TX
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Zip | 78596-6648
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Country | US
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Telephone | 956-968-9392
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Fax | 956-968-5722
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Authorized Official
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Title or Position | GENERAL PARTNER
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Name | DR. ROGER R HEREDIA
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Credential | MD
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Telephone | 956-968-9392
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QR0400X
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Taxonomy Name | Rehabilitation Clinic/Center
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License Number | 640450000
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License Number State | TX
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Taxonomy #2
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Taxonomy Code | 261QR0400X
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Taxonomy Name | Rehabilitation Clinic/Center
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License Number | 553070000
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License Number State | TX
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