Healthcare Provider Details

I. General information

NPI: 1184452153
Provider Name (Legal Business Name): CLINICA SAN JOSE PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/22/2024
Last Update Date: 05/01/2025
Certification Date: 05/01/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6423 MCPHERSON RD STE 13
LAREDO TX
78041-6144
US

IV. Provider business mailing address

6423 MCPHERSON RD STE 13
LAREDO TX
78041-6144
US

V. Phone/Fax

Practice location:
  • Phone: 956-251-9687
  • Fax:
Mailing address:
  • Phone: 956-452-1457
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QP2300X
TaxonomyPrimary Care Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: JORGE GOMEZ-VAZQUEZ
Title or Position: OWNER
Credential: MD
Phone: 956-452-1457