MEDICARE: LOS BARRIOS UNIDOS COMMUNITY CLINIC, INC.

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	261QF0400X	Federally Qualified Health Center (FQHC)

General Provider Information

NPI Number	:	1457802449
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LOS BARRIOS UNIDOS COMMUNITY CLINIC, INC.

Provider Business Mailing Address
First Line	:	809 SINGLETON BLVD
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75212-4014
Country	:	US
Telephone Number	:	214-540-0300
Fax Number	:

Provider Business Practice Location Address
First Line	:	4732 W ILLINOIS AVE
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75211-6502
Country	:	US
Telephone Number	:	214-540-0300
Fax Number	:

Authorized Official
Title or Position	:	CEO
Name	:	LEONOR MARQUEZ
Credential	:
Telephone Number	:	214-540-0302

Provider Enumeration Date	:	10/14/2016
Last Update Date	:	04/13/2026

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