Basic Information
| Provider Information | |||||||||
| NPI: | 1669855870 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | ISAAC ORNELAS | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 1029 | ||||||||
| Address2: | |||||||||
| City: | OLMITO | ||||||||
| State: | TX | ||||||||
| PostalCode: | 785751029 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9569821001 | ||||||||
| FaxNumber: | 9565444741 | ||||||||
| Practice Location | |||||||||
| Address1: | 3302 BOCA CHICA BLVD | ||||||||
| Address2: | |||||||||
| City: | BROWNSVILLE | ||||||||
| State: | TX | ||||||||
| PostalCode: | 785215193 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9569821001 | ||||||||
| FaxNumber: | 9565444741 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/07/2015 | ||||||||
| LastUpdateDate: | 07/07/2015 | ||||||||
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| AuthorizedOfficialLastName: | GARCIA | ||||||||
| AuthorizedOfficialFirstName: | VERONICA | ||||||||
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| AuthorizedOfficialTitleorPosition: | CREDENTIALING COORDINATOR | ||||||||
| AuthorizedOfficialTelephone: | 9569821001 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MRS. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225100000X | 1232455 | TX | Y | 193200000X MULTI-SPECIALTY GROUP | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist |
No ID Information.