Renuevate PA

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

License

L2172 Issued in TX

Legal business name

RENUEVATE PA

Practice address

119 Retama Street
Suite C
Elsa, TX 78543

Phone

(956) 567-2236

Fax

(956) 567-2013

NPI assigned

Jul 24, 2012

Organization subpart

No

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

Authorized official

Name

Dr. Eduardo Carrillo, M.D.

Title

Ceo

Phone

(956) 567-2236

Specialties & licenses 1

Addresses

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

{
    "created_epoch": "1343088000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1392336000000",
    "number": "1487900718",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "119 RETAMA STREET",
            "address_2": "SUITE C",
            "city": "ELSA",
            "state": "TX",
            "postal_code": "78543",
            "telephone_number": "956-567-2236",
            "fax_number": "956-567-2013"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "119 RETAMA STREET",
            "address_2": "SUITE C",
            "city": "ELSA",
            "state": "TX",
            "postal_code": "78543",
            "telephone_number": "956-567-2236",
            "fax_number": "956-567-2013"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "RENUEVATE PA",
        "organizational_subpart": "NO",
        "enumeration_date": "2012-07-24",
        "last_updated": "2014-02-14",
        "status": "A",
        "authorized_official_last_name": "CARRILLO",
        "authorized_official_first_name": "EDUARDO",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "956-567-2236",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Family Medicine",
            "state": "TX",
            "license": "L2172",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Performance Therapeutics - Elsa PLLC
• Performance Therapeutics-Elsa, PLLC
• Pharr Family Medical Center LLC
• Joshua Dennett Prado
• Quest Diagnostics Clinical Laboratories Inc
• Ricardo R. Gonzalez, O.D., P.a.
• Martin Rocha, PA
• Criselda V Rodriguez, COTA
• Jose Guadalupe Rodriguez III, CPHT
• Ruben Rodriguez, D.D.S.

• All providers in Elsa, TX
• Family Medicine Physician in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 14, 2014; 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.