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General NPI Number Information
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NPI Number | 1407000631
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Entity Type | Organization
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Legal Business Name | MI PUEBLO HOME HEALTH CARE, LLC
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Dates
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Enumeration Date | 11/14/2008
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Last Update Date | 11/14/2008
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Provider Practice Location Address
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Address Line | 2002 LINCOLN ST
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City | ZAPATA
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State | TX
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Zip | 78076-3563
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Country | US
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Telephone | 956-765-0088
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Fax | 956-765-0099
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Provider Business Mailing Address
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Address Line | P.O. BOX 14998 2002 LINCOLN ST.
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City | ZAPATA
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State | TX
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Zip | 78076-3563
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Country | US
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Telephone | 956-765-0088
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Fax | 956-765-0099
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Authorized Official
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Title or Position | ADMINISTRATOR
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Name | MRS. MARISOL N. GONZALEZ
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Credential | REGISTERED NURSE
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Telephone | 956-437-5654
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251E00000X
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Taxonomy Name | Home Health Agency
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License Number |
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License Number State |
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