Provider Demographics
NPI:1548041767
Name:SAN ISIDRO MEDICAL CENTER PLLC
Entity type:Organization
Organization Name:SAN ISIDRO MEDICAL CENTER PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:AUTHORIZED OFFICIAL
Authorized Official - Prefix:
Authorized Official - First Name:JAZIEL
Authorized Official - Middle Name:
Authorized Official - Last Name:SILVA-GONZALEZ
Authorized Official - Suffix:
Authorized Official - Credentials:AUDIOLOGIST
Authorized Official - Phone:956-462-5848
Mailing Address - Street 1:10414 MEDICAL LOOP UNIT F
Mailing Address - Street 2:
Mailing Address - City:LAREDO
Mailing Address - State:TX
Mailing Address - Zip Code:78045-6612
Mailing Address - Country:US
Mailing Address - Phone:956-462-5848
Mailing Address - Fax:956-462-5866
Practice Address - Street 1:10414 MEDICAL LOOP UNIT F
Practice Address - Street 2:
Practice Address - City:LAREDO
Practice Address - State:TX
Practice Address - Zip Code:78045-6612
Practice Address - Country:US
Practice Address - Phone:956-462-5848
Practice Address - Fax:956-462-5866
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-10-12
Last Update Date:2023-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QM1300XAmbulatory Health Care FacilitiesClinic/CenterMulti-SpecialtyGroup - Multi-Specialty
No207QG0300XAllopathic & Osteopathic PhysiciansFamily MedicineGeriatric MedicineGroup - Multi-Specialty
No133NN1002XDietary & Nutritional Service ProvidersNutritionistNutrition, EducationGroup - Multi-Specialty
No261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Multi-Specialty