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General NPI Number Information
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NPI Number | 1871126599
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Entity Type | Organization
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Legal Business Name | CLINICA NUEVO LEON, LLC
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Dates
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Enumeration Date | 02/20/2020
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Last Update Date | 12/01/2020
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Provider Practice Location Address
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Address Line | 3601 TOM GILL RD
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City | PENITAS
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State | TX
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Zip | 78576-7352
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Country | US
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Telephone | 956-778-4598
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Fax |
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Provider Business Mailing Address
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Address Line | 3601 TOM GILL RD
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City | PENITAS
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State | TX
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Zip | 78576-7352
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Country | US
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Telephone | 956-778-4598
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Fax |
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Authorized Official
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Title or Position | FAMILY NURSE PRACTITIONER/PROVIDER
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Name | MIGUEL A MATA
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Credential | FNP-C
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Telephone | 956-778-4598
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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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