Healthcare Provider Details

I. General information

NPI: 1346399201
Provider Name (Legal Business Name): FIESTA ADULT DAY CARE, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/09/2007
Last Update Date: 03/28/2024
Certification Date: 03/28/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6508 N BARTLETT AVE STE A
LAREDO TX
78041-6446
US

IV. Provider business mailing address

6508 N BARTLETT AVE STE A
LAREDO TX
78041-6446
US

V. Phone/Fax

Practice location:
  • Phone: 956-722-0159
  • Fax: 956-723-4690
Mailing address:
  • Phone: 956-722-0159
  • Fax: 956-723-4690

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code251J00000X
TaxonomyNursing Care Agency
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code261QA0600X
TaxonomyAdult Day Care Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: CLAUDIA GARCIA MONTEMAYOR
Title or Position: OWNER
Credential:
Phone: 956-722-0159