Provider Demographics
NPI:1821394255
Name:MCALLEN PEDIATRIC CLINIC
Entity Type:Organization
Organization Name:MCALLEN PEDIATRIC CLINIC
Other - Org Name:JUAN AGUILERA AND ASSOCIATES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JUAN
Authorized Official - Middle Name:A
Authorized Official - Last Name:AGUILERA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:956-283-1889
Mailing Address - Street 1:807 N CAGE BLVD
Mailing Address - Street 2:
Mailing Address - City:PHARR
Mailing Address - State:TX
Mailing Address - Zip Code:78577-3117
Mailing Address - Country:US
Mailing Address - Phone:956-283-1889
Mailing Address - Fax:956-283-7014
Practice Address - Street 1:2201 S 23RD ST
Practice Address - Street 2:
Practice Address - City:MCALLEN
Practice Address - State:TX
Practice Address - Zip Code:78503-5659
Practice Address - Country:US
Practice Address - Phone:956-928-1143
Practice Address - Fax:956-928-1831
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-02-02
Last Update Date:2011-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX=========OtherTAX ID