Healthcare Provider Details

I. General information

NPI: 1295946127
Provider Name (Legal Business Name): LA FUENTE INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/24/2007
Last Update Date: 08/23/2023
Certification Date: 08/23/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1285 E EXPRESSWAY 83
SULLIVAN CITY TX
78595
US

IV. Provider business mailing address

PO BOX 280
SULLIVAN CITY TX
78595-0280
US

V. Phone/Fax

Practice location:
  • Phone: 956-485-9650
  • Fax: 956-485-9652
Mailing address:
  • Phone: 956-485-9650
  • Fax: 956-485-9652

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA0600X
TaxonomyAdult Day Care Clinic/Center
License Number118857
License Number StateTX

VIII. Authorized Official

Name: VERONICA ALEMAN
Title or Position: ADMINISTRATOR
Credential:
Phone: 956-485-2400