Provider Demographics
NPI:1134328453
Name:RESENDEZ, EDELMIRA O
Entity Type:Individual
Prefix:MS
First Name:EDELMIRA
Middle Name:O
Last Name:RESENDEZ
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:820 E US HIGHWAY 77
Mailing Address - Street 2:SUITE A
Mailing Address - City:SAN BENITO
Mailing Address - State:TX
Mailing Address - Zip Code:78586-5570
Mailing Address - Country:US
Mailing Address - Phone:956-399-4997
Mailing Address - Fax:
Practice Address - Street 1:820 E US HIGHWAY 77 SUITE A
Practice Address - Street 2:
Practice Address - City:SAN BENITO
Practice Address - State:TX
Practice Address - Zip Code:78586-5570
Practice Address - Country:US
Practice Address - Phone:956-399-4997
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-07-16
Last Update Date:2020-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX115418261QA0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA0600XAmbulatory Health Care FacilitiesClinic/CenterAdult Day Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX000305700Medicaid