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General NPI Number Information
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NPI Number | 1184924060
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Entity Type | Organization
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Legal Business Name | LAREDO FAMILY NITE CLINIC P.A.
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Dates
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Enumeration Date | 10/26/2010
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Last Update Date | 06/08/2011
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Provider Practice Location Address
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Address Line | 7210 MCPHERSON RD STE 220
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City | LAREDO
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State | TX
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Zip | 78041-6505
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Country | US
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Telephone | 956-729-9766
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Fax | 956-729-8131
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Provider Business Mailing Address
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Address Line | 7210 MCPHERSON STE 220
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City | LAREDO
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State | TX
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Zip | 78041-6505
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Country | US
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Telephone | 956-729-9766
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Fax | 956-729-8131
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Authorized Official
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Title or Position | PRESIDENT
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Name | JESUS I AGUIRRE-BURGOS
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Credential | M.D.
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Telephone | 956-729-9766
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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 | E6206
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License Number State | TX
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