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General NPI Number Information
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NPI Number | 1700216132
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Entity Type | Organization
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Legal Business Name | SOUTH LAREDO HEALTH CARE CLINIC
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Dates
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Enumeration Date | 11/21/2013
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Last Update Date | 11/21/2013
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Provider Practice Location Address
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Address Line | 2110 LOMAS DEL SUR STE 103
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City | LAREDO
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State | TX
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Zip | 78046-5751
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Country | US
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Telephone | 956-489-0098
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Fax |
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Provider Business Mailing Address
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Address Line | 2110 LOMAS DEL SUR STE 103
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City | LAREDO
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State | TX
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Zip | 78046-5751
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Country | US
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Telephone | 956-489-0098
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Fax |
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Authorized Official
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Title or Position | MANAGER
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Name | MR. HECTOR EMILIO GARCIA
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Credential | FNP
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Telephone | 956-286-6834
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261Q00000X
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Taxonomy Name | Clinic/Center
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License Number | 653204
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License Number State | TX
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