Providence Neurology Clinic PA

Primary specialty

Neurology PhysicianTaxonomy code 2084N0400X

License

N3913 Issued in TX

Legal business name

PROVIDENCE NEUROLOGY CLINIC PA

Practice address

220 W Hillside Rd
Suite 5 B
Laredo, TX 78041-6903

Phone

(956) 717-4074

Fax

(956) 717-4186

NPI assigned

Oct 7, 2009

Organization subpart

No

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

Authorized official

Name

Dr. Grace Mukamana, MD

Title

MD/Owner

Phone

(956) 717-4074

Specialties & licenses 2

Addresses

Other identifiers 1

Locations

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

{
    "created_epoch": "1254873600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1340236800000",
    "number": "1144555251",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "220 W HILLSIDE RD",
            "address_2": "SUITE 5 B",
            "city": "LAREDO",
            "state": "TX",
            "postal_code": "780416903",
            "telephone_number": "956-717-4074",
            "fax_number": "956-717-4186"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "220 W HILLSIDE RD",
            "address_2": "SUITE 5 B",
            "city": "LAREDO",
            "state": "TX",
            "postal_code": "780416903",
            "telephone_number": "956-717-4074",
            "fax_number": "956-717-4186"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PROVIDENCE NEUROLOGY CLINIC PA",
        "organizational_subpart": "NO",
        "enumeration_date": "2009-10-07",
        "last_updated": "2012-06-21",
        "status": "A",
        "authorized_official_last_name": "MUKAMANA",
        "authorized_official_first_name": "GRACE",
        "authorized_official_title_or_position": "MD/OWNER",
        "authorized_official_telephone_number": "956-717-4074",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "2084N0400X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Psychiatry & Neurology, Neurology",
            "state": "TX",
            "license": "N3913",
            "primary": true
        },
        {
            "code": "2084N0600X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Psychiatry & Neurology, Clinical Neurophysiology",
            "state": "TX",
            "license": "N3913",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "210191701",
            "state": "TX"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Professional Radiation Services, PLLC
• Professional Skilled Services, Inc.
• Professional Skilled Services. Inc.
• Providence Hospital Anesthesia
• Providence Hospital LP
• Siegfried Pueblitz, MD
• Leslie Janeth Puente, SLP INTERN
• Leticia Puente
• John Valentine Puig II, M.D.
• Elda Pullin, SLP ASSISTANT

• Neurology Physician in Laredo, TX
• Providers in Laredo, TX by specialty
• Neurology Physician in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 21, 2012; 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.