Provider Demographics
NPI:1619082435
Name:MCALLEN PEDIATRIC CLINIC, P.A.
Entity Type:Organization
Organization Name:MCALLEN PEDIATRIC CLINIC, P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:
Authorized Official - Last Name:ROSTENBERG
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:956-682-6346
Mailing Address - Street 1:1801 S 5TH ST
Mailing Address - Street 2:SUITE 114
Mailing Address - City:MCALLEN
Mailing Address - State:TX
Mailing Address - Zip Code:78503-2927
Mailing Address - Country:US
Mailing Address - Phone:956-682-6346
Mailing Address - Fax:956-618-1199
Practice Address - Street 1:1801 S 5TH ST
Practice Address - Street 2:SUITE 114
Practice Address - City:MCALLEN
Practice Address - State:TX
Practice Address - Zip Code:78503-2927
Practice Address - Country:US
Practice Address - Phone:956-682-6346
Practice Address - Fax:956-618-1199
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-20
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX00P740Medicare ID - Type Unspecified