Provider Demographics
NPI:1306967708
Name:RANGEL, MARIO ALBERTO (NURSE PRACTITIONER)
Entity type:Individual
Prefix:
First Name:MARIO
Middle Name:ALBERTO
Last Name:RANGEL
Suffix:
Gender:M
Credentials:NURSE PRACTITIONER
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3213 LANCELOT LN
Mailing Address - Street 2:
Mailing Address - City:EDINBURG
Mailing Address - State:TX
Mailing Address - Zip Code:78539-3431
Mailing Address - Country:US
Mailing Address - Phone:956-499-5319
Mailing Address - Fax:
Practice Address - Street 1:2010 S CYNTHIA ST STE 110
Practice Address - Street 2:
Practice Address - City:MCALLEN
Practice Address - State:TX
Practice Address - Zip Code:78503-1387
Practice Address - Country:US
Practice Address - Phone:956-687-6963
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX667409163WG0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WG0000XNursing Service ProvidersRegistered NurseGeneral Practice