1376842377 NPI number — CATALINA GONZALEZ GARCIA

Table of content: (NPI 1376842377)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1376842377 NPI number — CATALINA GONZALEZ GARCIA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CATALINA GONZALEZ GARCIA
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
MIS AMIGOS DE WESLACO ADULT DAY CARE
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1376842377
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
10/29/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
707 ANGELITA DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
WESLACO
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
78599-4324
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
956-968-4018
Provider Business Mailing Address Fax Number:
956-968-4787

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
707 ANGELITA DR
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
WESLACO
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
78599-4324
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
956-968-4018
Provider Business Practice Location Address Fax Number:
956-968-4787
Provider Enumeration Date:
03/16/2011

Additional Information

Authorized Official

Authorized Official Last Name:
GONZALEZ GARCIA
Authorized Official First Name:
CATALINA
Authorized Official Middle Name:
Authorized Official Title or Position:
DBA
Authorized Official Telephone Number:
956-380-6249

Provider Taxonomy Codes

  • Taxonomy code: 261QA0600X , with the licence number:  001016883 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 1376842377 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1019665 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".




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