Provider Demographics
NPI:1689330649
Name:UNIVERSITY OF TEXAS RIO GRANDE VALLEY
Entity Type:Organization
Organization Name:UNIVERSITY OF TEXAS RIO GRANDE VALLEY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SR. MED STAFF COORD.
Authorized Official - Prefix:
Authorized Official - First Name:ELSA
Authorized Official - Middle Name:
Authorized Official - Last Name:MORALES
Authorized Official - Suffix:
Authorized Official - Credentials:CPCS, CPMSM
Authorized Official - Phone:956-296-1437
Mailing Address - Street 1:2102 TREASURE HILLS BLVD # 3.14406
Mailing Address - Street 2:
Mailing Address - City:HARLINGEN
Mailing Address - State:TX
Mailing Address - Zip Code:78550-8736
Mailing Address - Country:US
Mailing Address - Phone:956-296-1437
Mailing Address - Fax:956-296-6842
Practice Address - Street 1:2902 HAINE DRIVE, STE. #1.201
Practice Address - Street 2:
Practice Address - City:HARLINGEN
Practice Address - State:TX
Practice Address - Zip Code:78550-7855
Practice Address - Country:US
Practice Address - Phone:956-296-3974
Practice Address - Fax:956-296-2843
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-11-15
Last Update Date:2021-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes293D00000XLaboratoriesPhysiological Laboratory