Provider Demographics
NPI:1366633513
Name:PERFORMANCE ENHANCING NUTRITION
Entity Type:Organization
Organization Name:PERFORMANCE ENHANCING NUTRITION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JOSE
Authorized Official - Middle Name:
Authorized Official - Last Name:RODRIGUEZ
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:956-584-9000
Mailing Address - Street 1:801 E. NOLANA AVE
Mailing Address - Street 2:SUITE 4
Mailing Address - City:MCALLEN
Mailing Address - State:TX
Mailing Address - Zip Code:78504-6113
Mailing Address - Country:US
Mailing Address - Phone:956-686-2626
Mailing Address - Fax:956-686-1616
Practice Address - Street 1:801 E. NOLANA AVE
Practice Address - Street 2:SUITE 4
Practice Address - City:MCALLEN
Practice Address - State:TX
Practice Address - Zip Code:78504-6113
Practice Address - Country:US
Practice Address - Phone:956-686-2626
Practice Address - Fax:956-686-1616
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-05
Last Update Date:2010-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXH2734207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterologyGroup - Single Specialty