=====================================================
General NPI Number Information
=====================================================
NPI Number | 1346907607
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | COASTAL BEND WELLNESS FOUNDATION INC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 11/22/2021
-----------------------------------------------------
Last Update Date | 04/29/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 720 E LEE AVE
-----------------------------------------------------
City | KINGSVILLE
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 78363-4606
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 361-290-7672
-----------------------------------------------------
Fax | 877-928-8238
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2882 HOLLY RD
-----------------------------------------------------
City | CORPUS CHRISTI
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 78415-4106
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 361-814-2001
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | COO
-----------------------------------------------------
Name | AUGUSTIN DELAGARZA
-----------------------------------------------------
Credential | MHA
-----------------------------------------------------
Telephone | 361-814-2001
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261QF0400X
-----------------------------------------------------
Taxonomy Name | Federally Qualified Health Center (FQHC)
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------