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General NPI Number Information
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NPI Number | 1679997738
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Entity Type | Organization
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Legal Business Name | CIMARRON FAMILY PRACTICE AND NEURO MEDICAL CLINIC, PLLC
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Dates
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Enumeration Date | 02/10/2014
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Last Update Date | 02/10/2014
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Provider Practice Location Address
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Address Line | 901 TRAVIS ST SUITE 1
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City | MISSION
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State | TX
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Zip | 78572-2514
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Country | US
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Telephone | 956-739-7705
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Fax |
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Provider Business Mailing Address
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Address Line | 901 TRAVIS ST SUITE 1
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City | MISSION
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State | TX
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Zip | 78572-2514
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Country | US
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Telephone | 956-739-7705
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | MR. JUAN J MARTINEZ
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Credential |
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Telephone | 956-739-7705
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207T00000X
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Taxonomy Name | Neurological Surgery Physician
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License Number | E3723
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License Number State | TX
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