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General NPI Number Information
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NPI Number | 1780618975
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Entity Type | Organization
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Legal Business Name | HACIENDA FAMILY CLINIC L.T.D
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Dates
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Enumeration Date | 07/11/2006
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Last Update Date | 07/21/2022
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Provider Practice Location Address
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Address Line | RR 26 BOX 6766-49
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City | MISSION
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State | TX
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Zip | 78574-2582
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Country | US
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Telephone | 956-424-9863
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Fax | 956-424-9868
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Provider Business Mailing Address
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Address Line | RR 26 BOX 6766-49
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City | MISSION
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State | TX
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Zip | 78574-2582
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Country | US
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Telephone | 956-424-9863
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Fax | 956-424-9868
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Authorized Official
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Title or Position | PHYCIAN ASSITANT
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Name | MR. MANUEL ANTONIO PUIG
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Credential | PAC
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Telephone | 956-424-9863
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QH0100X
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Taxonomy Name | Health Service Clinic/Center
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License Number |
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License Number State |
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