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General NPI Number Information
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NPI Number | 1154715977
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Entity Type | Organization
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Legal Business Name | CLINICA BETESDA CORPORATION
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Dates
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Enumeration Date | 03/19/2015
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Last Update Date | 09/15/2015
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Provider Practice Location Address
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Address Line | 1100 GRAND AVENUE PKWY
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City | PFLUGERVILLE
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State | TX
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Zip | 78660-2194
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Country | US
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Telephone | 512-579-7249
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Fax | 512-551-0047
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Provider Business Mailing Address
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Address Line | 1100 GRAND AVENUE PKWY
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City | PFLUGERVILLE
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State | TX
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Zip | 78660-2194
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Country | US
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Telephone | 512-579-7249
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Fax | 512-551-0047
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Authorized Official
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Title or Position | CEO
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Name | MRS. MARIA ELENA GUTIERREZ
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Credential | MSN
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Telephone | 512-587-0732
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261Q00000X
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Taxonomy Name | Clinic/Center
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License Number |
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License Number State |
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