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General NPI Number Information
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NPI Number | 1134983158
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Entity Type | Organization
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Legal Business Name | PREMIUM FAMILY MEDICINE PLLC
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Dates
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Enumeration Date | 02/09/2024
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Last Update Date | 02/09/2024
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Provider Practice Location Address
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Address Line | 645 VILLA MARIA BLVD STE A
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City | BROWNSVILLE
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State | TX
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Zip | 78520-6370
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Country | US
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Telephone | 956-550-0999
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Fax | 956-550-0993
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Provider Business Mailing Address
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Address Line | 645 VILLA MARIA BLVD STE A
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City | BROWNSVILLE
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State | TX
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Zip | 78520-6370
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Country | US
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Telephone | 956-550-0999
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Fax |
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Authorized Official
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Title or Position | PRACTITIONER
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Name | MR. ABRAHAM MARTINEZ BARRIENTES
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Credential | MSN, APRN, FNP-BC
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Telephone | 956-550-0999
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208D00000X
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Taxonomy Name | General Practice Physician
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 363LP2300X
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Taxonomy Name | Primary Care Nurse Practitioner
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number |
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License Number State |
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