Provider Demographics
NPI:1679876924
Name:RONALDO D FACTORIZA,.M.D.P.A.
Entity Type:Organization
Organization Name:RONALDO D FACTORIZA,.M.D.P.A.
Other - Org Name:ST ANTHONY FAMILY CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:RONALDO
Authorized Official - Middle Name:DICTADO
Authorized Official - Last Name:FACTORIZA
Authorized Official - Suffix:
Authorized Official - Credentials:MD PA
Authorized Official - Phone:956-541-9499
Mailing Address - Street 1:PO BOX 3638
Mailing Address - Street 2:
Mailing Address - City:BROWNSVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:78523-3638
Mailing Address - Country:US
Mailing Address - Phone:956-541-9499
Mailing Address - Fax:956-541-1321
Practice Address - Street 1:680 PAREDES LINE RD
Practice Address - Street 2:
Practice Address - City:BROWNSVILLE
Practice Address - State:TX
Practice Address - Zip Code:78521-2482
Practice Address - Country:US
Practice Address - Phone:956-541-9499
Practice Address - Fax:956-541-1321
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-12-08
Last Update Date:2011-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXK5923207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX046636903Medicaid
TX046636903Medicaid
TX00489QMedicare PIN