Provider Demographics
NPI:1477202232
Name:UNIVERSITY OF TEXAS RIO GRANDE VALLEY
Entity Type:Organization
Organization Name:UNIVERSITY OF TEXAS RIO GRANDE VALLEY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ASSISTANT VICE PRESIDENT, CLINICAL
Authorized Official - Prefix:
Authorized Official - First Name:SANDRA
Authorized Official - Middle Name:
Authorized Official - Last Name:OWEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:956-296-1636
Mailing Address - Street 1:2102 TREASURE HILLS BLVD # 3.14406
Mailing Address - Street 2:
Mailing Address - City:HARLINGEN
Mailing Address - State:TX
Mailing Address - Zip Code:78550-8736
Mailing Address - Country:US
Mailing Address - Phone:956-296-1636
Mailing Address - Fax:956-296-6842
Practice Address - Street 1:723 SANTA ISABEL BLVD
Practice Address - Street 2:
Practice Address - City:LAGUNA VISTA
Practice Address - State:TX
Practice Address - Zip Code:78578-2647
Practice Address - Country:US
Practice Address - Phone:956-296-5889
Practice Address - Fax:956-296-5885
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-03-21
Last Update Date:2022-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR1300XAmbulatory Health Care FacilitiesClinic/CenterRural Health