Provider Demographics
NPI:1477629285
Name:RIO GRANDE VALLEY PEDIATRIC GASTROENTEROLOGY, P.A.
Entity Type:Organization
Organization Name:RIO GRANDE VALLEY PEDIATRIC GASTROENTEROLOGY, P.A.
Other - Org Name:RGV PEDIATRIC GASTROENTEROLOGY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MANUEL
Authorized Official - Middle Name:ADOLFO
Authorized Official - Last Name:REINOSO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:956-928-0400
Mailing Address - Street 1:1400 E RIDGE RD
Mailing Address - Street 2:SUITE 7
Mailing Address - City:MCALLEN
Mailing Address - State:TX
Mailing Address - Zip Code:78503-1535
Mailing Address - Country:US
Mailing Address - Phone:956-928-0400
Mailing Address - Fax:800-928-0537
Practice Address - Street 1:1400 E RIDGE RD
Practice Address - Street 2:SUITE 7
Practice Address - City:MCALLEN
Practice Address - State:TX
Practice Address - Zip Code:78503-1536
Practice Address - Country:US
Practice Address - Phone:956-928-0400
Practice Address - Fax:956-928-0411
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-27
Last Update Date:2011-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2080P0206XAllopathic & Osteopathic PhysiciansPediatricsPediatric GastroenterologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX165171301Medicaid