Provider Demographics
NPI:1558589853
Name:RGV FOOTCARE PA
Entity Type:Organization
Organization Name:RGV FOOTCARE PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:GUADALUPE
Authorized Official - Middle Name:JAVIER
Authorized Official - Last Name:CAVAZOS
Authorized Official - Suffix:JR
Authorized Official - Credentials:DPM
Authorized Official - Phone:956-618-2970
Mailing Address - Street 1:1401 E RIDGE RD
Mailing Address - Street 2:SUITE E
Mailing Address - City:MCALLEN
Mailing Address - State:TX
Mailing Address - Zip Code:78503-1524
Mailing Address - Country:US
Mailing Address - Phone:956-618-2970
Mailing Address - Fax:956-618-2398
Practice Address - Street 1:1401 E RIDGE RD
Practice Address - Street 2:SUITE E
Practice Address - City:MCALLEN
Practice Address - State:TX
Practice Address - Zip Code:78503-1524
Practice Address - Country:US
Practice Address - Phone:956-618-2970
Practice Address - Fax:956-618-2398
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-23
Last Update Date:2008-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1263213EP1101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213EP1101XPodiatric Medicine & Surgery Service ProvidersPodiatristPrimary Podiatric MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX176854101Medicaid
TX5346420001Medicare NSC
TX176854101Medicaid