Provider Demographics
NPI:1003900838
Name:PALOMA HEALTHCARE LLC
Entity Type:Organization
Organization Name:PALOMA HEALTHCARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BUSINESS MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:MARY
Authorized Official - Middle Name:
Authorized Official - Last Name:RUIZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:956-541-9797
Mailing Address - Street 1:864 CENTRAL BLVD., STE 200
Mailing Address - Street 2:
Mailing Address - City:BROWNSVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:78520
Mailing Address - Country:US
Mailing Address - Phone:956-541-9797
Mailing Address - Fax:956-541-9393
Practice Address - Street 1:864 CENTRAL BLVD., STE 200
Practice Address - Street 2:
Practice Address - City:BROWNSVILLE
Practice Address - State:TX
Practice Address - Zip Code:78520
Practice Address - Country:US
Practice Address - Phone:956-541-9797
Practice Address - Fax:956-541-9393
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-03
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0200XAmbulatory Health Care FacilitiesClinic/CenterRadiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX0247DCOtherBCBS PROVIDER NUMBER
TX4565098OtherAETNA PROVIDER NUMBER
TXFTXU19Medicare ID - Type UnspecifiedMEDICARE PROVIDER NUMBER