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General NPI Number Information
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NPI Number | 1548951718
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Entity Type | Organization
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Legal Business Name | CLINICAS SIN FRONTERAS FORT WORTH INC
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Dates
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Enumeration Date | 05/17/2023
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Last Update Date | 05/18/2023
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Provider Practice Location Address
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Address Line | 106 E SEMINARY DR
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City | FORT WORTH
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State | TX
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Zip | 76115-2632
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Country | US
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Telephone | 817-439-9146
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Fax |
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Provider Business Mailing Address
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Address Line | 2312 CONROE CT
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City | FLOWER MOUND
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State | TX
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Zip | 75028-2376
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | GONZALO MATA
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Credential |
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Telephone | 214-926-0298
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number |
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License Number State |
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