Healthcare Provider Details

I. General information

NPI: 1649703430
Provider Name (Legal Business Name): CLINICA MD LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/07/2017
Last Update Date: 12/03/2025
Certification Date: 12/03/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

103 HALL RD
SEAGOVILLE TX
75159-2915
US

IV. Provider business mailing address

103 HALL RD
SEAGOVILLE TX
75159-2915
US

V. Phone/Fax

Practice location:
  • Phone: 972-693-1944
  • Fax:
Mailing address:
  • Phone: 972-693-1944
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAP131702
License Number StateTX

VIII. Authorized Official

Name: LISSA THOMAS
Title or Position: CEO
Credential: NP
Phone: 972-693-1944