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General NPI Number Information
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NPI Number | 1346665429
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Entity Type | Organization
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Legal Business Name | HOMAR'S BUILDING AND REMODELING
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Dates
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Enumeration Date | 02/26/2014
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Last Update Date | 02/26/2014
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Provider Practice Location Address
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Address Line | 7832 GASTIN DR
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City | BROWNSVILLE
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State | TX
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Zip | 78520-3937
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Country | US
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Telephone | 956-639-1498
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Fax |
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Provider Business Mailing Address
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Address Line | 7832 GASTIN DR
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City | BROWNSVILLE
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State | TX
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Zip | 78520-3937
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Country | US
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Telephone | 956-639-1498
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Fax |
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Authorized Official
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Title or Position | CONTRACTOR
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Name | MR. HOMAR MATA
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Credential |
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Telephone | 956-639-1498
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 302F00000X
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Taxonomy Name | Exclusive Provider Organization
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License Number | 33488
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License Number State | TX
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Taxonomy #2
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Taxonomy Code | 302R00000X
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Taxonomy Name | Health Maintenance Organization
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License Number | 33488
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License Number State | TX
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