Provider Demographics
NPI:1164455671
Name:SOUTHEAST TEXAS CARDIOLOGY ASSOCIATES II LLP
Entity Type:Organization
Organization Name:SOUTHEAST TEXAS CARDIOLOGY ASSOCIATES II LLP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:RODOLFO
Authorized Official - Middle Name:PABLO
Authorized Official - Last Name:SOTOLONGO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:409-835-2112
Mailing Address - Street 1:PO BOX 7410
Mailing Address - Street 2:
Mailing Address - City:BEAUMONT
Mailing Address - State:TX
Mailing Address - Zip Code:77726-7410
Mailing Address - Country:US
Mailing Address - Phone:409-835-2112
Mailing Address - Fax:409-839-8988
Practice Address - Street 1:2693 NORTH ST
Practice Address - Street 2:
Practice Address - City:BEAUMONT
Practice Address - State:TX
Practice Address - Zip Code:77702-1624
Practice Address - Country:US
Practice Address - Phone:409-832-8862
Practice Address - Fax:409-835-5132
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-08
Last Update Date:2008-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular DiseaseGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX127017501Medicaid
TX127017504Medicaid
TX127017504Medicaid
TX0053AHMedicare UPIN