Provider Demographics
NPI:1649974106
Name:JOEL PEREZ RODRIGUEZ
Entity type:Organization
Organization Name:JOEL PEREZ RODRIGUEZ
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JOEL
Authorized Official - Middle Name:
Authorized Official - Last Name:PEREZ RODRIGUEZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:619-349-6409
Mailing Address - Street 1:410 S 15TH ST SUITE 2261
Mailing Address - Street 2:
Mailing Address - City:MCALLEN
Mailing Address - State:TX
Mailing Address - Zip Code:78501
Mailing Address - Country:US
Mailing Address - Phone:899-206-9138
Mailing Address - Fax:619-354-2449
Practice Address - Street 1:AVENIDA MIGUEL ALEMAN #103
Practice Address - Street 2:
Practice Address - City:REYNOSA
Practice Address - State:TAMAULIPAS
Practice Address - Zip Code:88550
Practice Address - Country:MX
Practice Address - Phone:899-206-9138
Practice Address - Fax:619-354-2449
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-03-29
Last Update Date:2023-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty