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General NPI Number Information
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NPI Number | 1922476506
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Entity Type | Organization
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Legal Business Name | LOS LAGOS HEALTHCARE INC.
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Dates
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Enumeration Date | 09/12/2015
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Last Update Date | 09/12/2015
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Provider Practice Location Address
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Address Line | 839 RICARDO AVE STE B
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City | PALMVIEW
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State | TX
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Zip | 78574-5210
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Country | US
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Telephone | 956-533-2174
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Fax |
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Provider Business Mailing Address
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Address Line | 839 RICARDO AVE STE B
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City | PALMVIEW
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State | TX
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Zip | 78574-5210
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Country | US
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Telephone | 956-533-2174
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | MR. RAUL CARRILLO
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Credential | RN
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Telephone | 956-533-2174
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251E00000X
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Taxonomy Name | Home Health Agency
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License Number |
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License Number State |
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