Provider Demographics
NPI:1003660895
Name:CLINICA DE LA FAMILIA HISPANA EBENEZER
Entity Type:Organization
Organization Name:CLINICA DE LA FAMILIA HISPANA EBENEZER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ADDEL
Authorized Official - Middle Name:
Authorized Official - Last Name:CASTELLANOS MATOS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:786-532-3663
Mailing Address - Street 1:522 BEDFORD RD
Mailing Address - Street 2:
Mailing Address - City:BEDFORD
Mailing Address - State:TX
Mailing Address - Zip Code:76022-6505
Mailing Address - Country:US
Mailing Address - Phone:682-738-3358
Mailing Address - Fax:682-738-3117
Practice Address - Street 1:522 BEDFORD RD
Practice Address - Street 2:
Practice Address - City:BEDFORD
Practice Address - State:TX
Practice Address - Zip Code:76022-6505
Practice Address - Country:US
Practice Address - Phone:682-738-3358
Practice Address - Fax:682-738-3117
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-04-16
Last Update Date:2024-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty