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General NPI Number Information
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NPI Number | 1871287094
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Entity Type | Organization
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Legal Business Name | CENTRO MEDICO INTEGRAL HISPANO LLC
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Dates
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Enumeration Date | 06/08/2023
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Last Update Date | 06/08/2023
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Provider Practice Location Address
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Address Line | 2110 N GALLOWAY AVE STE 108
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City | MESQUITE
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State | TX
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Zip | 75150-5779
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Country | US
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Telephone | 305-539-8084
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Fax |
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Provider Business Mailing Address
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Address Line | 2110 N GALLOWAY AVE STE 108
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City | MESQUITE
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State | TX
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Zip | 75150-5779
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Country | US
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Telephone | 305-539-8084
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Fax |
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Authorized Official
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Title or Position | AUTHORIZE OFFICIAL/OWNER
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Name | ROSELIO PEREZ GARCIA
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Credential | FNP
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Telephone | 214-647-1165
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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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