Provider Demographics
NPI:1528493459
Name:DEL BOSQUE, RENE III (PA)
Entity type:Individual
Prefix:MR
First Name:RENE
Middle Name:
Last Name:DEL BOSQUE
Suffix:III
Gender:M
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3901 NORTHERN LIGHTS AVE
Mailing Address - Street 2:
Mailing Address - City:EDINBURG
Mailing Address - State:TX
Mailing Address - Zip Code:78541-1983
Mailing Address - Country:US
Mailing Address - Phone:956-451-7905
Mailing Address - Fax:956-451-7905
Practice Address - Street 1:3901 NORTHERN LIGHTS AVE
Practice Address - Street 2:
Practice Address - City:EDINBURG
Practice Address - State:TX
Practice Address - Zip Code:78541-1983
Practice Address - Country:US
Practice Address - Phone:956-451-7905
Practice Address - Fax:956-451-7905
Is Sole Proprietor?:No
Enumeration Date:2013-09-10
Last Update Date:2024-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXPA08324363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX358731YLPSOtherWELLMED PTAN
TX340157201Medicaid