Healthcare Provider Details

I. General information

NPI: 1255075362
Provider Name (Legal Business Name): CENTER FOR HEALTH SERVICES,LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/25/2022
Last Update Date: 08/31/2023
Certification Date: 08/31/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

818 MARTIN RD SUITE 3
AMARILLO TX
77365
US

IV. Provider business mailing address

PO BOX 2799
PORTER TX
77365-2799
US

V. Phone/Fax

Practice location:
  • Phone: 806-418-4366
  • Fax: 806-418-4365
Mailing address:
  • Phone: 281-381-6190
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: ALIESKI MASTRAPA DOMINGUEZ
Title or Position: MEMBER
Credential:
Phone: 281-381-6190