Organization
GUSTAVO C LICEA MDPA
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. GUSTAVO C LICEA MD (OWNER)
(956) 664-9771
Entity
Organization
Contact information
Practice address
2010 S CYNTHIA ST, STE 101, MCALLEN, TX 78503-1386
(956) 664-9771
(956) 664-9773
Mailing address
PO BOX 720162, MCALLEN, TX 78504-0162
(956) 664-9771
(956) 664-9773
Taxonomy
Speciality
Code
Description
License number
State
207L00000X
Anesthesiology Physician
Primary
—
—
Other
Enumeration date
02/20/2013
Last updated
02/20/2013
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