Provider Demographics
NPI:1396908638
Name:PRIMO ABEL MAYHUA
Entity type:Organization
Organization Name:PRIMO ABEL MAYHUA
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:PRIMO
Authorized Official - Middle Name:ABEL
Authorized Official - Last Name:MAYHUA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:956-369-1787
Mailing Address - Street 1:3807 PLANTATION GROVE BLVD
Mailing Address - Street 2:APT G 201
Mailing Address - City:MISSION
Mailing Address - State:TX
Mailing Address - Zip Code:78572-7246
Mailing Address - Country:US
Mailing Address - Phone:956-369-1787
Mailing Address - Fax:956-581-9927
Practice Address - Street 1:900 S BRYAN RD
Practice Address - Street 2:
Practice Address - City:MISSION
Practice Address - State:TX
Practice Address - Zip Code:78572-6613
Practice Address - Country:US
Practice Address - Phone:956-383-9800
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-07-07
Last Update Date:2008-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXM1914207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXI42893Medicare UPIN
TX612644Medicare PIN