Provider Demographics
NPI:1427438100
Name:RYSTY ENTERPRISES, INC
Entity type:Organization
Organization Name:RYSTY ENTERPRISES, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JULIAN
Authorized Official - Middle Name:
Authorized Official - Last Name:YBARRA
Authorized Official - Suffix:JR
Authorized Official - Credentials:
Authorized Official - Phone:956-580-9922
Mailing Address - Street 1:2805 FOUNTAIN PLAZA BLVD
Mailing Address - Street 2:
Mailing Address - City:EDINBURG
Mailing Address - State:TX
Mailing Address - Zip Code:78539-8031
Mailing Address - Country:US
Mailing Address - Phone:956-316-2224
Mailing Address - Fax:956-316-0445
Practice Address - Street 1:1112 E GRIFFIN PKWY
Practice Address - Street 2:STE. C
Practice Address - City:MISSION
Practice Address - State:TX
Practice Address - Zip Code:78572-2408
Practice Address - Country:US
Practice Address - Phone:956-580-9922
Practice Address - Fax:956-580-9927
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-06-08
Last Update Date:2015-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Multi-Specialty
No111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty
No207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty