| Organization Name: | PROVIDENCE MEDICAL AND GERIATRIC ASSOCIATES, PA |
| NPI Number: | 1942409198 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | OLGA MARIA OLIVARES-HERRERA (PRESIDENT) |
| Mailing Address: | 110 E Savannah Ave Bldg C Suite 103 Mcallen |
| State: | TX US |
| Postal Code: | 785031241 |
| Phone Number: | 9569718800 |
| Fax Number: | 9569718804 |
| NPI Enumeration Date: | 07/17/2007 |
| NPI Last Update Date: | 06/10/2016 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 208D00000X |
| License Number: | M2431 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | TX |
| Taxonomy Type: | Allopathic & Osteopathic Physicians |
| Taxonomy Classification: | General Practice |
| Taxonomy Specialization: | |
| Taxonomy Definition: | |