Individual provider Active NPI

Edelmira O Resendez

  • Adult Day Care Clinic/Center
  • San Benito, TX
National Provider Identifier
1134328453
Registry record updated Mar 13, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Adult Day Care Clinic/CenterTaxonomy code 261QA0600X
License
115418 Issued in TX
Practice address
820 E US Highway 77 Suite a
San Benito, TX 78586-5570
Phone
(956) 399-4997
NPI assigned
Jul 16, 2007
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Mar 13, 2020

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Adult Day Care Clinic/Center 261QA0600X 115418 TX Primary

Addresses

Primary practice location

820 E US Highway 77 Suite a
San Benito, TX 78586-5570

Mailing address

820 E US Highway 77
Suite a
San Benito, TX 78586-5570
Phone (956) 399-4997

Other practice location 1

1300 Combes St
San Benito, TX 78586-3432
Phone (956) 399-4997

Other practice location 2

820 E US Highway 77
San Benito, TX 78586-5570
Phone (956) 399-4997

Other identifiers 1

IdentifierTypeStateIssuer
000305700MedicaidTX

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Not enrolled

State licenses

LicenseStateTypeSpecialty
115418TXMDAdult Day Care Clinic/Center

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1184544000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1584057600000",
    "number": "1134328453",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "820 E US HIGHWAY 77",
            "address_2": "SUITE A",
            "city": "SAN BENITO",
            "state": "TX",
            "postal_code": "785865570",
            "telephone_number": "956-399-4997"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "820 E US HIGHWAY 77 SUITE A",
            "city": "SAN BENITO",
            "state": "TX",
            "postal_code": "785865570",
            "telephone_number": "956-399-4997"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1300 Combes St",
            "address_purpose": "LOCATION",
            "city": "San Benito",
            "state": "TX",
            "postal_code": "785863432",
            "country_code": "US",
            "telephone_number": "956-399-4997",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "820 E US Highway 77",
            "address_purpose": "LOCATION",
            "city": "San Benito",
            "state": "TX",
            "postal_code": "785865570",
            "country_code": "US",
            "telephone_number": "956-399-4997",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "RESENDEZ",
        "first_name": "EDELMIRA",
        "middle_name": "O",
        "name_prefix": "Ms.",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2007-07-16",
        "last_updated": "2020-03-13",
        "certification_date": "2020-03-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "261QA0600X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Adult Day Care",
            "state": "TX",
            "license": "115418",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "000305700",
            "state": "TX"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in San Benito, TX

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 13, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.