Individual
CHI Y RHA
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
D.D.S
Contact information
Practice address
1301 LOS EBANOS, BLDG. D, BROWNSVILLE, TX 78520
(956) 541-7766
Mailing address
5462 AUTUMN MIST, BROWNSVILLE, TX 78526
(956) 541-1016
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
18650
TX
1223G0001X
General Practice Dentistry
51686
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
B1865001
CHIP
TX
01
—
G6026701
CHIP
TX
Enumeration date
09/15/2006
Last updated
01/22/2008
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