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General NPI Number Information
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NPI Number | 1801582655
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Entity Type | Organization
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Legal Business Name | CLINICA GUADALUPE BROADWAY LLC
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Dates
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Enumeration Date | 04/14/2023
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Last Update Date | 04/14/2023
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Provider Practice Location Address
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Address Line | 5956 BROADWAY BLVD
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City | GARLAND
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State | TX
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Zip | 75043-5822
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Country | US
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Telephone | 469-367-0248
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Fax | 469-367-0126
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Provider Business Mailing Address
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Address Line | 14951 DALLAS PKWY STE 190
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City | DALLAS
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State | TX
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Zip | 75254-6894
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | OFFICER
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Name | CINDY OLALDE
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Credential |
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Telephone | 214-240-1506
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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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