Provider Demographics
NPI:1548491863
Name:RIO VALLEY DERMATOLOGY, PA
Entity type:Organization
Organization Name:RIO VALLEY DERMATOLOGY, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DERMATOLOGIST / DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:ROBERT
Authorized Official - Last Name:HOHNADEL
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:956-621-0979
Mailing Address - Street 1:1110 SANTA ANA AVE
Mailing Address - Street 2:
Mailing Address - City:RANCHO VIEJO
Mailing Address - State:TX
Mailing Address - Zip Code:78575-9772
Mailing Address - Country:US
Mailing Address - Phone:956-627-0979
Mailing Address - Fax:817-741-7516
Practice Address - Street 1:864 CENTRAL BLVD
Practice Address - Street 2:SUITE 3000
Practice Address - City:BROWNSVILLE
Practice Address - State:TX
Practice Address - Zip Code:78520-7551
Practice Address - Country:US
Practice Address - Phone:972-977-3733
Practice Address - Fax:817-741-7516
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-08-04
Last Update Date:2009-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXL7420207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatologyGroup - Single Specialty