1508342080 NPI number — ANGELITOS PHC PI LLC

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1508342080 NPI number — ANGELITOS PHC PI LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ANGELITOS PHC PI LLC
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:
Provider Other Organization Name Type Code:
6
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:
1508342080
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/17/2018
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
704 E GRIFFIN PKWY
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MISSION
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
78572-2972
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
956-624-6965
Provider Business Mailing Address Fax Number:
956-581-9918

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
134 S SHORE DR STE 110
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
PORT ISABEL
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
78578-2544
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
956-624-6965
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
07/17/2018

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
GARCIA
Authorized Official First Name:
FRANCES
Authorized Official Middle Name:
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
956-624-6965

Provider Taxonomy Codes

  • Taxonomy code: 247200000X , registered in the state of NULL ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 251J00000X , 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)