MEDICARE: CLINICA SAN JOSE PLLC

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	261QP2300X	Primary Care Clinic/Center
2	207Q00000X	Family Medicine Physician

General Provider Information

NPI Number	:	1184452153
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CLINICA SAN JOSE PLLC

Provider Business Mailing Address
First Line	:	6423 MCPHERSON RD STE 13
Second Line	:
City	:	LAREDO
State	:	TX
Zip	:	78041-6144
Country	:	US
Telephone Number	:	956-452-1457
Fax Number	:

Provider Business Practice Location Address
First Line	:	6423 MCPHERSON RD STE 13
Second Line	:
City	:	LAREDO
State	:	TX
Zip	:	78041-6144
Country	:	US
Telephone Number	:	956-251-9687
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	JORGE GOMEZ-VAZQUEZ
Credential	:	MD
Telephone Number	:	956-452-1457

Provider Enumeration Date	:	07/22/2024
Last Update Date	:	05/01/2025

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Directions to “CLINICA SAN JOSE PLLC ” Practice Location

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