Provider Demographics
NPI:1083150924
Name:CAUBA, ANTHONY REGINALD J
Entity type:Individual
Prefix:
First Name:ANTHONY REGINALD
Middle Name:J
Last Name:CAUBA
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3009 VIOLET AVE
Mailing Address - Street 2:
Mailing Address - City:MCALLEN
Mailing Address - State:TX
Mailing Address - Zip Code:78504-5292
Mailing Address - Country:US
Mailing Address - Phone:956-627-6354
Mailing Address - Fax:
Practice Address - Street 1:416 LINDBERG AVE
Practice Address - Street 2:SUITE A
Practice Address - City:MCALLEN
Practice Address - State:TX
Practice Address - Zip Code:78501-2922
Practice Address - Country:US
Practice Address - Phone:956-630-4161
Practice Address - Fax:956-664-7989
Is Sole Proprietor?:No
Enumeration Date:2017-01-17
Last Update Date:2017-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAP132613363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner