Healthcare Provider Details

I. General information

NPI: 1942398151
Provider Name (Legal Business Name): LITTLE LIGHTHOUSE CHILDRENS REHAB
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/11/2006
Last Update Date: 04/25/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

503 W OCEAN BLVD STE B
LOS FRESNOS TX
78566-3620
US

IV. Provider business mailing address

503 W OCEAN BLVD STE B
LOS FRESNOS TX
78566-3620
US

V. Phone/Fax

Practice location:
  • Phone: 956-233-4111
  • Fax: 956-233-4115
Mailing address:
  • Phone: 956-233-4111
  • Fax: 956-233-4115

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QR0400X
TaxonomyRehabilitation Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MR. RICK LEE PEREZ
Title or Position: ASSITANT ADMINISTRATOR
Credential:
Phone: 956-943-9600