Organization Name: | ALICE INTERNAL MEDICINE CONSULTANTS |
NPI Number: | 1124110044 |
Entity Type Code: | Organizational (2) |
Authorized Official Name: | ROBERTO FABRICIO DIAZ (PRESIDENT) |
Mailing Address: | 2510 E Main St Suite 102 Alice |
State: | TX US |
Postal Code: | 783324187 |
Phone Number: | 3616644445 |
Fax Number: | 3646644449 |
NPI Enumeration Date: | 09/28/2006 |
NPI Last Update Date: | 05/03/2012 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 363AM0700X |
License Number: | |
Healthcare Provider Taxonomy: (Secondary) | N |
State: | |
Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
Taxonomy Classification: | Physician Assistant |
Taxonomy Specialization: | Medical |
Taxonomy Definition: |