Basic Information
| Provider Information | |||||||||
| NPI: | 1831389170 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | ORONA | ||||||||
| FirstName: | JESSE | ||||||||
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| Credential: | H.I.S. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 26222 RR 12 | ||||||||
| Address2: | |||||||||
| City: | DRIPPING SPRINGS | ||||||||
| State: | TX | ||||||||
| PostalCode: | 786204903 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5128580300 | ||||||||
| FaxNumber: | 5128582714 | ||||||||
| Practice Location | |||||||||
| Address1: | 1201 S JACKSON RD | ||||||||
| Address2: | |||||||||
| City: | PHARR | ||||||||
| State: | TX | ||||||||
| PostalCode: | 785776859 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9566181668 | ||||||||
| FaxNumber: | 9562830040 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/01/2007 | ||||||||
| LastUpdateDate: | 11/13/2009 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 237600000X | N | Speech, Language and Hearing Service Providers | Audiologist-Hearing Aid Fitter | 237700000X | 50427 | TX | Y | Speech, Language and Hearing Service Providers | Hearing Instrument Specialist |
ID Information
| ID | Type | State | Issuer | Description | 50427 | 01 | TX | SCFDHI | OTHER | 2037699-01 | 05 | TX | MEDICAID |