Healthcare Provider Details

I. General information

NPI: 1184401697
Provider Name (Legal Business Name): ONE MED CLINIC LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/11/2023
Last Update Date: 09/12/2023
Certification Date: 09/12/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1520 E SAN PEDRO ST STE 102
LAREDO TX
78041-5479
US

IV. Provider business mailing address

203 SABAL LOOP
LAREDO TX
78045-5015
US

V. Phone/Fax

Practice location:
  • Phone: 956-285-4327
  • Fax:
Mailing address:
  • Phone: 956-285-4327
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QH0100X
TaxonomyHealth Service Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QM1000X
TaxonomyMigrant Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: JOSE ALVARADO
Title or Position: OWNER
Credential: DNP, APRN, FNP-C
Phone: 956-285-4327