Healthcare Provider Details

I. General information

NPI: 1619338068
Provider Name (Legal Business Name): EL DIAMANTE PHC, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/13/2016
Last Update Date: 01/31/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 W 2ND ST SUITE 4
LA JOYA TX
78560-9088
US

IV. Provider business mailing address

100 W 2ND ST SUITE 4
LA JOYA TX
78560-9088
US

V. Phone/Fax

Practice location:
  • Phone: 956-519-4509
  • Fax: 956-519-4531
Mailing address:
  • Phone: 956-519-4509
  • Fax: 956-519-4531

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code3747P1801X
TaxonomyPersonal Care Attendant
License Number
License Number State

VIII. Authorized Official

Name: MS. ROSA VILLARREAL
Title or Position: CO-OWNER
Credential:
Phone: 956-519-4509