Provider Demographics
NPI:1720151392
Name:LUIS R. VENEGAS D.P.M.P.A.
Entity Type:Organization
Organization Name:LUIS R. VENEGAS D.P.M.P.A.
Other - Org Name:BROWNSVILLE PODIATRIC WOUND CARE AND SURGERY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OFFICE ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:JANNETTE
Authorized Official - Middle Name:
Authorized Official - Last Name:VENEGAS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:956-574-9733
Mailing Address - Street 1:5493 RUSTIC MANOR DR
Mailing Address - Street 2:
Mailing Address - City:BROWNSVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:78526-3920
Mailing Address - Country:US
Mailing Address - Phone:956-574-9733
Mailing Address - Fax:956-574-9730
Practice Address - Street 1:40 MARSELLA BLVD.
Practice Address - Street 2:
Practice Address - City:BROWNSVILLE
Practice Address - State:TX
Practice Address - Zip Code:78521
Practice Address - Country:US
Practice Address - Phone:956-574-9733
Practice Address - Fax:956-574-9730
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-15
Last Update Date:2022-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1452213ES0103X
TX1457213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX177638701Medicaid
TX177638701Medicaid
TX00400ZMedicare PIN
U56643Medicare UPIN