Provider Demographics
NPI:1487876496
Name:LONGORIA, LISA DOLORES (PA-C)
Entity type:Individual
Prefix:MISS
First Name:LISA
Middle Name:DOLORES
Last Name:LONGORIA
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 749
Mailing Address - Street 2:
Mailing Address - City:PHARR
Mailing Address - State:TX
Mailing Address - Zip Code:78577-1614
Mailing Address - Country:US
Mailing Address - Phone:956-362-2410
Mailing Address - Fax:956-362-2414
Practice Address - Street 1:1100 E DOVE AVE STE 202
Practice Address - Street 2:
Practice Address - City:MCALLEN
Practice Address - State:TX
Practice Address - Zip Code:78504-4681
Practice Address - Country:US
Practice Address - Phone:956-362-2410
Practice Address - Fax:956-362-2414
Is Sole Proprietor?:No
Enumeration Date:2007-05-02
Last Update Date:2025-06-05
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
TXPA04548363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXPA04548OtherSTATE LICENSE