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NPI Code Detail

MEDICARE: LA ESPERANZA CLINIC INC

MEDICARE: LA ESPERANZA 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
1261QF0400XFederally Qualified Health Center (FQHC)TX

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
200433TOTHERBCBS

General Provider Information

NPI Number : 1770584187
Entity Type Code : Organization
Provider Name (Legal Business Name) : LA ESPERANZA CLINIC INC
Provider Business Mailing Address
First Line : 1610 S CHADBOURNE ST
Second Line :
City : SAN ANGELO
State : TX
Zip : 76903-8510
Country : US
Telephone Number : 325-658-5339
Fax Number : 325-659-8534
Provider Business Practice Location Address
First Line : 1610 S CHADBOURNE ST
Second Line :
City : SAN ANGELO
State : TX
Zip : 76903-8510
Country : US
Telephone Number : 325-658-5339
Fax Number : 325-659-8534
Authorized Official
Title or Position : CFO
Name : ROSIE CASTANEDA
Credential :
Telephone Number : 325-947-5623
Provider Enumeration Date : 08/09/2005
Last Update Date : 01/08/2024

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Directions to “LA ESPERANZA CLINIC INC ” Practice Location

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