Provider Demographics
NPI:1558568212
Name:FALCON, ELI (OTR)
Entity Type:Individual
Prefix:MR
First Name:ELI
Middle Name:
Last Name:FALCON
Suffix:
Gender:M
Credentials:OTR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2108 S M ST STE 6
Mailing Address - Street 2:
Mailing Address - City:MCALLEN
Mailing Address - State:TX
Mailing Address - Zip Code:78503-1556
Mailing Address - Country:US
Mailing Address - Phone:956-457-2022
Mailing Address - Fax:956-668-7183
Practice Address - Street 1:2610 CORNERSTONE BLVD
Practice Address - Street 2:
Practice Address - City:EDINBURG
Practice Address - State:TX
Practice Address - Zip Code:78539-9122
Practice Address - Country:US
Practice Address - Phone:956-668-1818
Practice Address - Fax:956-668-1819
Is Sole Proprietor?:No
Enumeration Date:2007-06-27
Last Update Date:2022-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX112224225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX022017001Medicaid
TX022017001Medicaid