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General NPI Number Information
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NPI Number | 1619219292
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Entity Type | Organization
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Legal Business Name | SU CLINICA AMIGA LLC
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Dates
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Enumeration Date | 03/21/2013
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Last Update Date | 03/21/2013
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Provider Practice Location Address
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Address Line | 3169 CALLE MARAVILLOSA
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City | BROWNSVILLE
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State | TX
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Zip | 78526-1240
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Country | US
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Telephone | 832-356-7695
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Fax |
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Provider Business Mailing Address
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Address Line | 3169 CALLE MARAVILLOSA
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City | BROWNSVILLE
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State | TX
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Zip | 78526-1240
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Country | US
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Telephone | 832-356-7695
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | AMELIA ISBELL
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Credential |
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Telephone | 832-356-7695
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QP2300X
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Taxonomy Name | Primary Care Clinic/Center
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License Number | J6641
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License Number State | TX
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