Provider Demographics
NPI:1992494199
Name:EAR COOL OF SOUTH TEXAS PLLC
Entity type:Organization
Organization Name:EAR COOL OF SOUTH TEXAS PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:DIENA
Authorized Official - Middle Name:
Authorized Official - Last Name:GALLEGOS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:956-478-8947
Mailing Address - Street 1:210 S BRYAN RD STE 5A
Mailing Address - Street 2:
Mailing Address - City:MISSION
Mailing Address - State:TX
Mailing Address - Zip Code:78572-6204
Mailing Address - Country:US
Mailing Address - Phone:956-585-6611
Mailing Address - Fax:956-585-1822
Practice Address - Street 1:2210 E INTERSTATE HIGHWAY 2 STE 1
Practice Address - Street 2:
Practice Address - City:MISSION
Practice Address - State:TX
Practice Address - Zip Code:78572-0122
Practice Address - Country:US
Practice Address - Phone:956-585-6611
Practice Address - Fax:956-585-1822
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-05-03
Last Update Date:2023-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Multi-Specialty