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General NPI Number Information
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NPI Number | 1881834539
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Entity Type | Organization
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Legal Business Name | IRIS WELL CHILD PHYSICALS
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Dates
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Enumeration Date | 02/20/2009
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Last Update Date | 02/20/2009
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Provider Practice Location Address
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Address Line | 200 W. EDINBURG HWY 107 SUITE B
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City | ELSA
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State | TX
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Zip | 78543-1274
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Country | US
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Telephone | 956-262-9805
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Fax | 956-262-9233
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Provider Business Mailing Address
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Address Line | PO BOX 1274
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City | ELSA
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State | TX
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Zip | 78543-1274
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Country | US
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Telephone | 956-262-9805
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Fax | 956-262-9233
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Authorized Official
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Title or Position | OWNER
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Name | IRIS GARCIA
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Credential | R.N., PNP
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Telephone | 956-262-9805
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 364SP0200X
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Taxonomy Name | Pediatric Clinical Nurse Specialist
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License Number | 533197
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License Number State | TX
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