Provider Demographics
NPI:1659868958
Name:CORTEZ, RONALD REGALA (AGACNP)
Entity Type:Individual
Prefix:
First Name:RONALD
Middle Name:REGALA
Last Name:CORTEZ
Suffix:
Gender:M
Credentials:AGACNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3507 S RHONDA ST
Mailing Address - Street 2:
Mailing Address - City:EDINBURG
Mailing Address - State:TX
Mailing Address - Zip Code:78539-3136
Mailing Address - Country:US
Mailing Address - Phone:956-533-6905
Mailing Address - Fax:
Practice Address - Street 1:110 E. SAVANNAH AVE.
Practice Address - Street 2:BLDG B STE 203
Practice Address - City:MCALLEN
Practice Address - State:TX
Practice Address - Zip Code:78503
Practice Address - Country:US
Practice Address - Phone:956-686-7611
Practice Address - Fax:956-618-3164
Is Sole Proprietor?:Yes
Enumeration Date:2018-04-23
Last Update Date:2018-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAP137321363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute CareGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX8J5465OtherBCBS
TX696829OtherMEDICARE
TX388032001Medicaid