Basic Information
| Provider Information | |||||||||
| NPI: | 1164455671 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | SOUTHEAST TEXAS CARDIOLOGY ASSOCIATES II LLP | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 7410 | ||||||||
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| City: | BEAUMONT | ||||||||
| State: | TX | ||||||||
| PostalCode: | 777267410 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4098352112 | ||||||||
| FaxNumber: | 4098398988 | ||||||||
| Practice Location | |||||||||
| Address1: | 2693 NORTH ST | ||||||||
| Address2: | |||||||||
| City: | BEAUMONT | ||||||||
| State: | TX | ||||||||
| PostalCode: | 777021624 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4098328862 | ||||||||
| FaxNumber: | 4098355132 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/08/2006 | ||||||||
| LastUpdateDate: | 08/19/2008 | ||||||||
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| AuthorizedOfficialLastName: | SOTOLONGO | ||||||||
| AuthorizedOfficialFirstName: | RODOLFO | ||||||||
| AuthorizedOfficialMiddleName: | PABLO | ||||||||
| AuthorizedOfficialTitleorPosition: | PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 4098352112 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | MD | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207RC0000X | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Internal Medicine | Cardiovascular Disease |
ID Information
| ID | Type | State | Issuer | Description | 127017501 | 05 | TX | MEDICAID | 127017504 | 05 | TX | MEDICAID |