Organization Name: | SU CLINICA FAMILIAR |
NPI Number: | 1871516807 |
Entity Type Code: | Organizational (2) |
Authorized Official Name: | ADAM SALDIVAR (CFO) |
Mailing Address: | 131 Fm 3168 Raymondville |
State: | TX US |
Postal Code: | 785803605 |
Phone Number: | 9566892196 |
Fax Number: | 9566895937 |
NPI Enumeration Date: | 07/25/2006 |
NPI Last Update Date: | 07/09/2007 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 261QF0400X |
License Number: | |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | |
Taxonomy Type: | Ambulatory Health Care Facilities |
Taxonomy Classification: | Clinic/Center |
Taxonomy Specialization: | Federally Qualified Health Center (FQHC) |
Taxonomy Definition: |