Provider Demographics
NPI:1427504794
Name:LAGO VASALLO, OSBEL
Entity type:Individual
Prefix:
First Name:OSBEL
Middle Name:
Last Name:LAGO VASALLO
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 1:800 SANDPIPER AVE
Mailing Address - Street 2:UNIT A
Mailing Address - City:MCALLEN
Mailing Address - State:TX
Mailing Address - Zip Code:78504-1661
Mailing Address - Country:US
Mailing Address - Phone:956-258-3602
Mailing Address - Fax:
Practice Address - Street 1:800 SANDPIPER AVE
Practice Address - Street 2:UNIT A
Practice Address - City:MCALLEN
Practice Address - State:TX
Practice Address - Zip Code:78504-1661
Practice Address - Country:US
Practice Address - Phone:956-258-3602
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-08-28
Last Update Date:2020-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX16-459246ZC0007X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246ZC0007XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherSurgical Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX39692419OtherDRIVER LICENCE