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General NPI Number Information
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NPI Number | 1811639982
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Entity Type | Organization
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Legal Business Name | IZAGUIRREWC L L C
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Dates
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Enumeration Date | 04/10/2022
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Last Update Date | 01/20/2025
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Provider Practice Location Address
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Address Line | 1110 S STEWART RD STE B
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City | SAN JUAN
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State | TX
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Zip | 78589-5206
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Country | US
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Telephone | 956-884-4550
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Fax |
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Provider Business Mailing Address
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Address Line | 512 HUNEE DR
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City | SAN JUAN
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State | TX
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Zip | 78589-2755
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Country | US
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Telephone | 956-309-3290
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Fax |
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Authorized Official
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Title or Position | SOLE MEMBER /PRESIDENT
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Name | SAUL IZAGUIRRE
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Credential | NP
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Telephone | 956-648-2968
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number |
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License Number State |
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