1982948279 NPI number — STROMAN&GUTIERREZ FAMILY PRACTICE CLINIC AND MED SPA

Table of content: (NPI 1982948279)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1982948279 NPI number — STROMAN&GUTIERREZ FAMILY PRACTICE CLINIC AND MED SPA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
STROMAN&GUTIERREZ FAMILY PRACTICE CLINIC AND MED SPA
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:
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:
1982948279
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
11/27/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2990 N TEXAS BLVD STE A
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:
78596-9696
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
956-973-1757
Provider Business Mailing Address Fax Number:
956-973-0767

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
807 N CAGE BLVD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
PHARR
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
78577-3117
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
956-283-1889
Provider Business Practice Location Address Fax Number:
956-283-7014
Provider Enumeration Date:
11/27/2012

Additional Information

Authorized Official

Authorized Official Last Name:
GARCIA
Authorized Official First Name:
CYNTHIA
Authorized Official Middle Name:
Authorized Official Title or Position:
CREDENTIALING
Authorized Official Telephone Number:
956-283-1889

Provider Taxonomy Codes

  • Taxonomy code: 207Q00000X , with the licence number:  M9035 , 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)





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