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General NPI Number Information
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NPI Number | 1578672457
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Entity Type | Organization
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Legal Business Name | SAN MIGUEL FAMILY MEDICAL CLINIC, P.A.
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Dates
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Enumeration Date | 08/30/2006
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Last Update Date | 12/04/2009
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Provider Practice Location Address
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Address Line | 713 N WARE RD
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City | MCALLEN
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State | TX
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Zip | 78501-6616
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Country | US
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Telephone | 956-682-8496
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Fax | 956-682-0590
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Provider Business Mailing Address
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Address Line | 713 N WARE RD
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City | MCALLEN
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State | TX
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Zip | 78501-6616
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Country | US
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Telephone | 956-682-8496
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Fax | 956-682-0590
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. LUIS G SAN MIGUEL
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Credential | D.O.
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Telephone | 956-682-8496
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | K5201
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License Number State | TX
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