Healthcare Provider Details

I. General information

NPI: 1760436877
Provider Name (Legal Business Name): ASSOCIATION FOR THE ADVANCEMENT OF MEXICAN AMERICANS,INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/22/2006
Last Update Date: 12/08/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

204 CLIFTON ST
HOUSTON TX
77011-3314
US

IV. Provider business mailing address

434 S MAIN
SAN ANTONIO TX
78204-1118
US

V. Phone/Fax

Practice location:
  • Phone: 713-926-9491
  • Fax:
Mailing address:
  • Phone: 210-270-8575
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code291U00000X
TaxonomyClinical Medical Laboratory
License Number45D1019277
License Number StateTX

VIII. Authorized Official

Name: MS. ESPERANZA SMITH
Title or Position: QUALITY ASSURANCE MANAGER
Credential: ,LCDC
Phone: 210-270-8575