Basic Information
| Provider Information | |||||||||
| NPI: | 1427438100 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | RYSTY ENTERPRISES, INC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2805 FOUNTAIN PLAZA BLVD | ||||||||
| Address2: | |||||||||
| City: | EDINBURG | ||||||||
| State: | TX | ||||||||
| PostalCode: | 785398031 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9563162224 | ||||||||
| FaxNumber: | 9563160445 | ||||||||
| Practice Location | |||||||||
| Address1: | 1112 E GRIFFIN PKWY | ||||||||
| Address2: | STE. C | ||||||||
| City: | MISSION | ||||||||
| State: | TX | ||||||||
| PostalCode: | 785722408 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9565809922 | ||||||||
| FaxNumber: | 9565809927 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/08/2015 | ||||||||
| LastUpdateDate: | 06/08/2015 | ||||||||
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| AuthorizedOfficialLastName: | YBARRA | ||||||||
| AuthorizedOfficialFirstName: | JULIAN | ||||||||
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| AuthorizedOfficialTitleorPosition: | OWNER | ||||||||
| AuthorizedOfficialTelephone: | 9565809922 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNameSuffix: | JR. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 111N00000X | N | 193200000X MULTI-SPECIALTY GROUP | Chiropractic Providers | Chiropractor | 207Q00000X | N | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Family Medicine | 363LF0000X | Y | 193200000X MULTI-SPECIALTY GROUP | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Family |
No ID Information.