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NPI Code Detail

MEDICARE: CLINICAS SIN FRONTERAS FORT WORTH INC

MEDICARE: CLINICAS SIN FRONTERAS FORT WORTH INC
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1363L00000XNurse Practitioner

General Provider Information

NPI Number : 1548951718
Entity Type Code : Organization
Provider Name (Legal Business Name) : CLINICAS SIN FRONTERAS FORT WORTH INC
Provider Business Mailing Address
First Line : 2312 CONROE CT
Second Line :
City : FLOWER MOUND
State : TX
Zip : 75028-2376
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 106 E SEMINARY DR
Second Line :
City : FORT WORTH
State : TX
Zip : 76115-2632
Country : US
Telephone Number : 817-439-9146
Fax Number :
Authorized Official
Title or Position : OWNER
Name : GONZALO MATA
Credential :
Telephone Number : 214-926-0298
Provider Enumeration Date : 05/17/2023
Last Update Date : 05/18/2023

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Directions to “CLINICAS SIN FRONTERAS FORT WORTH INC ” Practice Location

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