RUBEN R RONCALLO MD PA
Ambulatory Health at Mesa St, El Paso, TX

License number
Texas K9162
Category
Ambulatory Health
Type
Primary Care
Owner
Name: EDGARDO ANTONIO CERA
Title: MANAGER
Phone: (915) 532-9000
Address
Address
4500 N Mesa St, El Paso, TX 79912
National Provider ID: 1881004737
LicenseFiles verified this license of Nov 7, 2017 at the National Plan and Provider Enumeration System.

Organization information

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RUBEN R RONCALLO MD PA

4500 N Mesa St, El Paso, TX 79912

Doing business as:
Ruben R Roncallo MD PA
Registration:
Feb 20, 2013
State ID:
0801737679
Business type:
Professional Association
Secretary, Director, Member, President:
Ruben Rafael Roncallo (Secretary, Director, Member, President)
Agent:
Ruben R Roncallo,4500 N Mesa, El Paso, TX 79912 (Physical)
TIN:
32050236739

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