Basic Information
| Provider Information | |||||||||
| NPI: | 1902289119 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | CASQUERO LEON | ||||||||
| FirstName: | JORGE | ||||||||
| MiddleName: | LUIS | ||||||||
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| Credential: | M.D | ||||||||
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| Mailing Information | |||||||||
| Address1: | 217 ULEX AVE | ||||||||
| Address2: | |||||||||
| City: | MCALLEN | ||||||||
| State: | TX | ||||||||
| PostalCode: | 785042641 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2037703505 | ||||||||
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| Practice Location | |||||||||
| Address1: | 2821 MICHAELANGELO DR STE 400 | ||||||||
| Address2: | |||||||||
| City: | EDINBURG | ||||||||
| State: | TX | ||||||||
| PostalCode: | 785391405 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9563623590 | ||||||||
| FaxNumber: | 9563623598 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/07/2015 | ||||||||
| LastUpdateDate: | 11/04/2021 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 11/04/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207V00000X | T1658 | TX | Y | Allopathic & Osteopathic Physicians | Obstetrics & Gynecology |
ID Information
| ID | Type | State | Issuer | Description | H08PX39301 | 01 | TX | BCBS | OTHER | 4291627-01 | 05 | TX | MEDICAID |