Provider Demographics
NPI:1770842098
Name:LAREDO ARTHRITIS & RHEUMATOLOGY CENTER, PLLC
Entity type:Organization
Organization Name:LAREDO ARTHRITIS & RHEUMATOLOGY CENTER, PLLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ANTONIO
Authorized Official - Middle Name:EMANUEL
Authorized Official - Last Name:MANCERA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:210-421-4131
Mailing Address - Street 1:7210 MCPHERSON RD
Mailing Address - Street 2:N230
Mailing Address - City:LAREDO
Mailing Address - State:TX
Mailing Address - Zip Code:78041-6507
Mailing Address - Country:US
Mailing Address - Phone:210-421-4131
Mailing Address - Fax:
Practice Address - Street 1:7210 MCPHERSON RD
Practice Address - Street 2:N230
Practice Address - City:LAREDO
Practice Address - State:TX
Practice Address - Zip Code:78041-6507
Practice Address - Country:US
Practice Address - Phone:210-421-4131
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-05-07
Last Update Date:2024-01-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RR0500XAllopathic & Osteopathic PhysiciansInternal MedicineRheumatologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXN5832OtherTX LICENSE