Provider Demographics
NPI:1467458422
Name:MIRELES QUINTANILLA, RUY
Entity Type:Individual
Prefix:
First Name:RUY
Middle Name:
Last Name:MIRELES QUINTANILLA
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1910 S 1ST ST
Mailing Address - Street 2:STE 200
Mailing Address - City:MCALLEN
Mailing Address - State:TX
Mailing Address - Zip Code:78503-1255
Mailing Address - Country:US
Mailing Address - Phone:956-687-7885
Mailing Address - Fax:956-687-3101
Practice Address - Street 1:1910 S 1ST ST
Practice Address - Street 2:STE 200
Practice Address - City:MCALLEN
Practice Address - State:TX
Practice Address - Zip Code:78503-1255
Practice Address - Country:US
Practice Address - Phone:956-687-7885
Practice Address - Fax:956-687-3101
Is Sole Proprietor?:Yes
Enumeration Date:2005-06-23
Last Update Date:2008-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXH1627174400000X, 2084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
No2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX032736301Medicaid
TXOODA93Medicare PIN
TX032736301Medicaid