MEDICARE: JIREH INTERNATIONAL SERVICE 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	261QD0000X	Dental Clinic/Center

General Provider Information

NPI Number	:	1598591042
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	JIREH INTERNATIONAL SERVICE LLC

Provider Business Mailing Address
First Line	:	3900 N JACKSON RD
Second Line	:
City	:	PHARR
State	:	TX
Zip	:	78577-7768
Country	:	US
Telephone Number	:	956-375-4695
Fax Number	:

Provider Business Practice Location Address
First Line	:	3900 N JACKSON RD
Second Line	:
City	:	PHARR
State	:	TX
Zip	:	78577-7768
Country	:	US
Telephone Number	:	956-375-4695
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	MARIA EUGENIA ZABALETA
Credential	:
Telephone Number	:	956-375-4695

Provider Enumeration Date	:	09/11/2024
Last Update Date	:	11/07/2024

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