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General NPI Number Information
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NPI Number | 1669794657
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Entity Type | Organization
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Legal Business Name | FAMILY CLINICS OF LAREDO PLLC
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Dates
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Enumeration Date | 02/18/2010
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Last Update Date | 08/09/2010
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Provider Practice Location Address
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Address Line | 3102 ROSS ST LOOP 20
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City | LAREDO
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State | TX
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Zip | 78043-4980
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Country | US
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Telephone | 956-727-3547
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Fax | 956-725-8737
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Provider Business Mailing Address
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Address Line | 101 W VILLAGE BLVD SUITE B
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City | LAREDO
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State | TX
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Zip | 78041-2211
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Country | US
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Telephone | 956-727-3047
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Fax | 956-717-3630
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Authorized Official
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Title or Position | MD
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Name | EDGAR A TREVINO
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Credential | MD
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Telephone | 956-285-7785
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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 |
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License Number State |
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