Provider Demographics
NPI:1730636606
Name:RGV PEDIATRIC SPECIAL CARE PA
Entity Type:Organization
Organization Name:RGV PEDIATRIC SPECIAL CARE PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:MARIA
Authorized Official - Middle Name:
Authorized Official - Last Name:CAMACHO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:956-421-2414
Mailing Address - Street 1:PO BOX 534358
Mailing Address - Street 2:
Mailing Address - City:HARLINGEN
Mailing Address - State:TX
Mailing Address - Zip Code:78553-4358
Mailing Address - Country:US
Mailing Address - Phone:956-421-2414
Mailing Address - Fax:956-421-3321
Practice Address - Street 1:4302 S SUGAR RD
Practice Address - Street 2:STE 205
Practice Address - City:EDINBURG
Practice Address - State:TX
Practice Address - Zip Code:78539-7073
Practice Address - Country:US
Practice Address - Phone:956-421-2414
Practice Address - Fax:956-421-3321
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-09-07
Last Update Date:2017-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Multi-Specialty
No2080P0203XAllopathic & Osteopathic PhysiciansPediatricsPediatric Critical Care MedicineGroup - Multi-Specialty