MEDICARE: ESSENTIAL OCCUPATIONAL HEALTH AND SAFETY II

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QX0100X	Occupational Medicine Clinic/Center

General Provider Information

NPI Number	:	1912654278
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ESSENTIAL OCCUPATIONAL HEALTH AND SAFETY II

Provider Business Mailing Address
First Line	:	5119 N MCCOLL RD
Second Line	:
City	:	MCALLEN
State	:	TX
Zip	:	78504-2331
Country	:	US
Telephone Number	:	956-331-8340
Fax Number	:

Provider Business Practice Location Address
First Line	:	5119 N MCCOLL RD
Second Line	:
City	:	MCALLEN
State	:	TX
Zip	:	78504-2331
Country	:	US
Telephone Number	:	956-331-8340
Fax Number	:

Authorized Official
Title or Position	:	MEMBER
Name	:	DR. MARC A IBANEZ
Credential	:	MD
Telephone Number	:	361-500-3121

Provider Enumeration Date	:	03/07/2022
Last Update Date	:	03/07/2022

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