Provider Demographics
NPI:1366738163
Name:IGLESIAS, SAMUEL ISAAC (PA-C)
Entity type:Individual
Prefix:MR
First Name:SAMUEL
Middle Name:ISAAC
Last Name:IGLESIAS
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 749
Mailing Address - Street 2:
Mailing Address - City:PHARR
Mailing Address - State:TX
Mailing Address - Zip Code:78577-1614
Mailing Address - Country:US
Mailing Address - Phone:956-362-8290
Mailing Address - Fax:956-362-8295
Practice Address - Street 1:2821 MICHAELANGELO DR STE 204
Practice Address - Street 2:
Practice Address - City:EDINBURG
Practice Address - State:TX
Practice Address - Zip Code:78539-1423
Practice Address - Country:US
Practice Address - Phone:956-362-8290
Practice Address - Fax:956-362-8295
Is Sole Proprietor?:No
Enumeration Date:2011-06-21
Last Update Date:2023-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX363AM0700X
TXPA07250363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical