Basic Information
| Provider Information | |||||||||
| NPI: | 1841862950 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | ICU DYNAMICS PLLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2206 SABINAL ST | ||||||||
| Address2: | |||||||||
| City: | MISSION | ||||||||
| State: | TX | ||||||||
| PostalCode: | 785727478 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9564503093 | ||||||||
| FaxNumber: | 9566319822 | ||||||||
| Practice Location | |||||||||
| Address1: | 1112 E GRIFFIN PKWY STE D | ||||||||
| Address2: | |||||||||
| City: | MISSION | ||||||||
| State: | TX | ||||||||
| PostalCode: | 785722408 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9564503093 | ||||||||
| FaxNumber: | 9566319822 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/16/2021 | ||||||||
| LastUpdateDate: | 07/16/2021 | ||||||||
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| AuthorizedOfficialLastName: | DEGORORDO ARZAMENDI | ||||||||
| AuthorizedOfficialFirstName: | ANTONIO | ||||||||
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| AuthorizedOfficialTitleorPosition: | DIRECTOR | ||||||||
| AuthorizedOfficialTelephone: | 9564503093 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | MD | ||||||||
| NPICertificationDate: | 07/16/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207RP1001X | Y | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Internal Medicine | Pulmonary Disease |
No ID Information.