Provider Demographics
NPI:1740626340
Name:MARIO R ANZALDUA MD PA
Entity type:Organization
Organization Name:MARIO R ANZALDUA MD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MARIO
Authorized Official - Middle Name:R
Authorized Official - Last Name:ANZALDUA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:956-519-7088
Mailing Address - Street 1:1512 E GRIFFIN PKWY STE 2
Mailing Address - Street 2:
Mailing Address - City:MISSION
Mailing Address - State:TX
Mailing Address - Zip Code:78572-2422
Mailing Address - Country:US
Mailing Address - Phone:956-519-7088
Mailing Address - Fax:956-519-9816
Practice Address - Street 1:1512 E GRIFFIN PKWY STE 2
Practice Address - Street 2:
Practice Address - City:MISSION
Practice Address - State:TX
Practice Address - Zip Code:78572-2422
Practice Address - Country:US
Practice Address - Phone:956-519-7088
Practice Address - Fax:956-519-9816
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-05-22
Last Update Date:2022-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXF9142207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXF9142OtherMEDICAL LICENSE