Provider Demographics
NPI:1770015950
Name:CANO PENALOZA, JOSE RAFAEL (MD)
Entity Type:Individual
Prefix:
First Name:JOSE
Middle Name:RAFAEL
Last Name:CANO PENALOZA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:JOSE
Other - Middle Name:RAFAEL
Other - Last Name:CANO
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:205 E TORONTO AVE
Mailing Address - Street 2:
Mailing Address - City:MCALLEN
Mailing Address - State:TX
Mailing Address - Zip Code:78503-1209
Mailing Address - Country:US
Mailing Address - Phone:956-687-6155
Mailing Address - Fax:956-618-0451
Practice Address - Street 1:205 E TORONTO AVE
Practice Address - Street 2:
Practice Address - City:MCALLEN
Practice Address - State:TX
Practice Address - Zip Code:78503-1209
Practice Address - Country:US
Practice Address - Phone:956-687-6155
Practice Address - Fax:956-682-0597
Is Sole Proprietor?:No
Enumeration Date:2017-03-28
Last Update Date:2020-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXS5337207Q00000X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program