MEDICARE: MI CLINICA HISPANA LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LP2300X	Primary Care Nurse Practitioner

General Provider Information

NPI Number	:	1093525206
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MI CLINICA HISPANA LLC

Provider Business Mailing Address
First Line	:	3505 SUMMERHILL RD STE 5
Second Line	:
City	:	TEXARKANA
State	:	TX
Zip	:	75503-3596
Country	:	US
Telephone Number	:	903-710-1400
Fax Number	:	903-710-1500

Provider Business Practice Location Address
First Line	:	3505 SUMMERHILL RD STE 5
Second Line	:
City	:	TEXARKANA
State	:	TX
Zip	:	75503-3596
Country	:	US
Telephone Number	:	903-710-1400
Fax Number	:	903-710-1500

Authorized Official
Title or Position	:	NURSE PRACTITIONER
Name	:	ALAINA HERNANDEZ
Credential	:	FNP-C
Telephone Number	:	903-710-1400

Provider Enumeration Date	:	01/09/2025
Last Update Date	:	03/03/2025

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