Provider Demographics
NPI:1083943161
Name:RAYITO DE SOL PEDIATRIC REHABILITATION CENTER
Entity Type:Organization
Organization Name:RAYITO DE SOL PEDIATRIC REHABILITATION CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SPEECH LANGUAGE PATHOLOGIST
Authorized Official - Prefix:MRS
Authorized Official - First Name:KARINA
Authorized Official - Middle Name:JOHANA
Authorized Official - Last Name:TANGUMA
Authorized Official - Suffix:
Authorized Official - Credentials:MS, CCC-SLP
Authorized Official - Phone:956-240-8090
Mailing Address - Street 1:2105 W. 3 MILE RD. UNIT 5
Mailing Address - Street 2:
Mailing Address - City:MISSION
Mailing Address - State:TX
Mailing Address - Zip Code:78573-6732
Mailing Address - Country:US
Mailing Address - Phone:956-240-8090
Mailing Address - Fax:
Practice Address - Street 1:2105 W 3 MILE RD UNIT 5
Practice Address - Street 2:
Practice Address - City:MISSION
Practice Address - State:TX
Practice Address - Zip Code:78573-6732
Practice Address - Country:US
Practice Address - Phone:956-240-8090
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-12-18
Last Update Date:2012-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0400XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation