Licea, Gustavo
Licea, Gustavo is an individual health care provider with primary practice located at 3513 W Alberta Rd , Edinburg TX 78539-8466. He recently has only one registered license in Allopathic & Osteopathic Physicians / Anesthesiology, which is considered as his primary health care specialty. Licea, Gustavo can be contacted via phone (956) 664-9771.Contact Information
Primary practice address
3513 W Alberta Rd
Edinburg TX 78539-8466
Phone: (956) 664-9771
Fax: (956) 664-9773
Website:
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Allopathic & Osteopathic Physicians / Anesthesiology | 207L00000X | J2657 | Texas |
Profile Details
| NPI number | 1871527036 |
|---|---|
| LBN Legal business name | Licea, Gustavo |
| Credentials | Doctor of Medicine (MD) |
| Entity | Individual |
| Sole proprietor 1 | No |
| Enumeration date | Jul 11th, 2006 |
| Last updated | Jul 8th, 2007 - about 19 years ago |
1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.
Identifiers
| State | Type | Number | Issuer |
|---|---|---|---|
| All States | NPI | 1871527036 | NPPES |
| Texas | MEDICAID | 130477604 |
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