Healthcare Provider Details

I. General information

NPI: 1801123237
Provider Name (Legal Business Name): CTJ CARINO PRIMARY CARE L.L.C
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/05/2009
Last Update Date: 02/04/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

909 MARKET ST
LAREDO TX
78040
US

IV. Provider business mailing address

3305 S MALINCHE AVE
LAREDO TX
78046-7144
US

V. Phone/Fax

Practice location:
  • Phone: 956-753-0008
  • Fax: 956-753-5677
Mailing address:
  • Phone: 956-718-9987
  • Fax:

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 Code251J00000X
TaxonomyNursing Care Agency
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code3747P1801X
TaxonomyPersonal Care Attendant
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code385H00000X
TaxonomyRespite Care
License Number
License Number State

VIII. Authorized Official

Name: CELINDA GALLEGOS
Title or Position: PRESIDENT
Credential:
Phone: 956-718-9987