Provider Demographics
NPI:1942734231
Name:PERFORMANCE THERAPEUTICS RIO GRANDECITY PLLC
Entity Type:Organization
Organization Name:PERFORMANCE THERAPEUTICS RIO GRANDECITY PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:OMAR
Authorized Official - Middle Name:
Authorized Official - Last Name:PALOMIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:956-488-1999
Mailing Address - Street 1:500 LINDBERG AVE
Mailing Address - Street 2:
Mailing Address - City:MCALLEN
Mailing Address - State:TX
Mailing Address - Zip Code:78501-2924
Mailing Address - Country:US
Mailing Address - Phone:956-488-1999
Mailing Address - Fax:
Practice Address - Street 1:201 N FM 3167
Practice Address - Street 2:UNIT E
Practice Address - City:RIO GRANDE CITY
Practice Address - State:TX
Practice Address - Zip Code:78582-6724
Practice Address - Country:US
Practice Address - Phone:956-488-1999
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-04-13
Last Update Date:2017-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX261QR0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0400XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation