Healthcare Provider Details

I. General information

NPI: 1053272351
Provider Name (Legal Business Name): CIELO AZUL LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/18/2025
Last Update Date: 11/18/2025
Certification Date: 11/04/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

40875 S FM 1015
PROGRESO TX
78579
US

IV. Provider business mailing address

PO BOX 951
PROGRESO TX
78579-0951
US

V. Phone/Fax

Practice location:
  • Phone: 956-607-6362
  • Fax: 956-294-1219
Mailing address:
  • Phone: 956-607-6362
  • Fax: 956-294-1219

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA0600X
TaxonomyAdult Day Care Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MELIDA ADRIANA MARQUEZ
Title or Position: DIRECTOR/OWNER
Credential:
Phone: 956-607-6362