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General NPI Number Information
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NPI Number | 1174604763
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Entity Type | Organization
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Legal Business Name | CLINICA FAMILIAR SAN JOSE, PA
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Dates
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Enumeration Date | 10/18/2006
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Last Update Date | 07/17/2013
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Provider Practice Location Address
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Address Line | 8030 N FM 1015 STE B
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City | MERCEDES
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State | TX
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Zip | 78570-4809
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Country | US
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Telephone | 956-825-9757
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Fax | 956-825-9125
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Provider Business Mailing Address
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Address Line | 8030 FM 1015 STE B
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City | MERCEDES
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State | TX
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Zip | 78570-4809
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Country | US
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Telephone | 956-825-9757
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Fax | 956-825-9125
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Authorized Official
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Title or Position | BUSINESS MANAGER
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Name | MRS. JUDY L KUTUGATA
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Credential | RN
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Telephone | 956-969-2904
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | TA03917
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License Number State | TX
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