MEDICARE: CENTRO SAN VICENTE

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)

Other Identifiers

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

General Provider Information

NPI Number	:	1780761452
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CENTRO SAN VICENTE

Provider Business Mailing Address
First Line	:	PO BOX 1517
Second Line	:
City	:	SAN ELIZARIO
State	:	TX
Zip	:	79849-1517
Country	:	US
Telephone Number	:	915-851-0999
Fax Number	:	915-851-6060

Provider Business Practice Location Address
First Line	:	13017 PERICO ST
Second Line	:
City	:	SAN ELIZARIO
State	:	TX
Zip	:	79849-1517
Country	:	US
Telephone Number	:	915-851-0999
Fax Number	:	915-851-6060

Authorized Official
Title or Position	:	CEO
Name	:	CHRISTINA ILENE PAZ
Credential	:
Telephone Number	:	915-859-7545

Provider Enumeration Date	:	11/01/2006
Last Update Date	:	05/06/2026

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Directions to “CENTRO SAN VICENTE ” Practice Location

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