Provider Demographics
NPI:1588220362
Name:RESENDEZ FAMILY PRACTICE PA
Entity Type:Organization
Organization Name:RESENDEZ FAMILY PRACTICE PA
Other - Org Name:MCALLEN HEALTH AND WELLNESS FAMILY PRACTICE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:VERONICA
Authorized Official - Middle Name:
Authorized Official - Last Name:RESENDEZ
Authorized Official - Suffix:
Authorized Official - Credentials:FNP
Authorized Official - Phone:956-631-3982
Mailing Address - Street 1:1200 E RIDGE RD STE 7
Mailing Address - Street 2:
Mailing Address - City:MCALLEN
Mailing Address - State:TX
Mailing Address - Zip Code:78503-1528
Mailing Address - Country:US
Mailing Address - Phone:956-631-3462
Mailing Address - Fax:956-631-0254
Practice Address - Street 1:1200 E RIDGE RD STE 7
Practice Address - Street 2:
Practice Address - City:MCALLEN
Practice Address - State:TX
Practice Address - Zip Code:78503-1528
Practice Address - Country:US
Practice Address - Phone:956-631-3982
Practice Address - Fax:956-631-0254
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-05-16
Last Update Date:2019-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX0796047-01Medicaid