Basic Information
| Provider Information | |||||||||
| NPI: | 1942734231 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | PERFORMANCE THERAPEUTICS RIO GRANDECITY PLLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 500 LINDBERG AVE | ||||||||
| Address2: | |||||||||
| City: | MCALLEN | ||||||||
| State: | TX | ||||||||
| PostalCode: | 785012924 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9564881999 | ||||||||
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| Practice Location | |||||||||
| Address1: | 201 N FM 3167 | ||||||||
| Address2: | UNIT E | ||||||||
| City: | RIO GRANDE CITY | ||||||||
| State: | TX | ||||||||
| PostalCode: | 785826724 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9564881999 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 04/13/2017 | ||||||||
| LastUpdateDate: | 04/13/2017 | ||||||||
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| AuthorizedOfficialLastName: | PALOMIN | ||||||||
| AuthorizedOfficialFirstName: | OMAR | ||||||||
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| AuthorizedOfficialTitleorPosition: | OWNER | ||||||||
| AuthorizedOfficialTelephone: | 9564881999 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261QR0400X | TX | Y | Ambulatory Health Care Facilities | Clinic/Center | Rehabilitation |
No ID Information.