Provider Demographics
NPI:1700860780
Name:OAFERINA PROFESSIONAL CORP.
Entity Type:Organization
Organization Name:OAFERINA PROFESSIONAL CORP.
Other - Org Name:ALTA VISTA REHABILITATION CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:BUSINESS MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:GLORIA
Authorized Official - Middle Name:MURILLO
Authorized Official - Last Name:OAFERINA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:956-791-8235
Mailing Address - Street 1:PO BOX 451267
Mailing Address - Street 2:
Mailing Address - City:LAREDO
Mailing Address - State:TX
Mailing Address - Zip Code:78045-0031
Mailing Address - Country:US
Mailing Address - Phone:956-791-8235
Mailing Address - Fax:956-791-8239
Practice Address - Street 1:209 W. VILLAGE BLVD
Practice Address - Street 2:SUITE 1
Practice Address - City:LAREDO
Practice Address - State:TX
Practice Address - Zip Code:78041
Practice Address - Country:US
Practice Address - Phone:956-791-8235
Practice Address - Fax:956-791-8239
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-12-02
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1076438225100000X
TX1103976225100000X
TX108458225X00000X
TX100504235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Not Answered225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty
Not Answered225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGroup - Multi-Specialty
Not Answered235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX=========OtherBCBS PROVIDER NO.
TX=========OtherBCBS PROVIDER NO.