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General NPI Number Information
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NPI Number | 1215485602
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Entity Type | Organization
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Legal Business Name | LA BUENA FE PHC CORPORATION
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Dates
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Enumeration Date | 09/14/2016
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Last Update Date | 07/25/2018
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Provider Practice Location Address
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Address Line | 2680 W. ALTON GLOOR STE #1
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City | BROWNSVILLE
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State | TX
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Zip | 78520
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Country | US
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Telephone | 956-621-0880
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Fax | 956-621-0961
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Provider Business Mailing Address
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Address Line | 2680 W. ALTON GLOOR STE #1
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City | BROWNSVILLE
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State | TX
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Zip | 78520
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Country | US
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Telephone | 956-621-0880
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Fax | 956-621-0961
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Authorized Official
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Title or Position | ADMINISTRATOR
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Name | MARIA GARCIA
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Credential |
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Telephone | 956-621-0880
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QP2300X
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Taxonomy Name | Primary Care Clinic/Center
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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 | 3747P1801X
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Taxonomy Name | Personal Care Attendant
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License Number | 017782
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License Number State | TX
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