1114162492 NPI number — RAUL ERNESTO LOAISIGA MD PA

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1114162492 NPI number — RAUL ERNESTO LOAISIGA MD PA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
RAUL ERNESTO LOAISIGA MD PA
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
LOAISIGA CHILDRENS CLINIC
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1114162492
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
05/22/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
4770 N EXPRESSWAY
Provider Second Line Business Mailing Address:
STE. 206
Provider Business Mailing Address City Name:
BROWNSVILLE
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
78526-4165
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
956-350-5500
Provider Business Mailing Address Fax Number:
956-350-4965

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4770 N EXPRESSWAY # 7783
Provider Second Line Business Practice Location Address:
STE 206
Provider Business Practice Location Address City Name:
BROWNSVILLE
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
78526-4120
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
956-350-5500
Provider Business Practice Location Address Fax Number:
956-350-4965
Provider Enumeration Date:
12/15/2008

Additional Information

Authorized Official

Authorized Official Last Name:
LOAISIGA
Authorized Official First Name:
RAUL
Authorized Official Middle Name:
ERNESTO
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
956-350-5500

Provider Taxonomy Codes

  • Taxonomy code: 208000000X , with the licence number:  L0383 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 198528501 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".




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