Healthcare Provider Details

I. General information

NPI: 1528026614
Provider Name (Legal Business Name): SAN JOSE HOME HEALTH
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/01/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

102 LAKE GENEVA DR
LAREDO TX
78041-1918
US

IV. Provider business mailing address

102 LAKE GENEVA DR
LAREDO TX
78041-1918
US

V. Phone/Fax

Practice location:
  • Phone: 956-725-0345
  • Fax:
Mailing address:
  • Phone: 956-725-0345
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WH0200X
TaxonomyHome Health Registered Nurse
License Number
License Number State

VIII. Authorized Official

Name: MISS CLAUDIA GABRIELA MUNOZ
Title or Position: ADMINISTRATOR
Credential: B.A.
Phone: 956-206-0108