Provider Demographics
NPI:1437346228
Name:HUMBERTO R. BRUSCHETTA, M.D., P.A.
Entity Type:Organization
Organization Name:HUMBERTO R. BRUSCHETTA, M.D., P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:HUMBERTO
Authorized Official - Middle Name:R
Authorized Official - Last Name:BRUSCHETTA
Authorized Official - Suffix:
Authorized Official - Credentials:MD, FACP
Authorized Official - Phone:361-516-0097
Mailing Address - Street 1:2511 EAST CORRAL AVE
Mailing Address - Street 2:
Mailing Address - City:KINGSVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:78363-4101
Mailing Address - Country:US
Mailing Address - Phone:361-516-0097
Mailing Address - Fax:361-516-0182
Practice Address - Street 1:2511 E CORRAL AVE
Practice Address - Street 2:
Practice Address - City:KINGSVILLE
Practice Address - State:TX
Practice Address - Zip Code:78363-4101
Practice Address - Country:US
Practice Address - Phone:361-516-0097
Practice Address - Fax:361-516-0182
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-09-26
Last Update Date:2010-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX9634207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX079672401Medicaid
TX1760437438OtherNPI
TX079672401Medicaid
TX00046NMedicare PIN