Provider Demographics
NPI:1063017739
Name:UPTOWN CLINIC PLLC
Entity Type:Organization
Organization Name:UPTOWN CLINIC PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:FNP-BC
Authorized Official - Prefix:
Authorized Official - First Name:ROSAURA
Authorized Official - Middle Name:
Authorized Official - Last Name:CANTU
Authorized Official - Suffix:
Authorized Official - Credentials:FNP-BC
Authorized Official - Phone:956-280-3271
Mailing Address - Street 1:155 UPTOWN AVE STE B
Mailing Address - Street 2:
Mailing Address - City:BROWNSVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:78520-7568
Mailing Address - Country:US
Mailing Address - Phone:956-620-3140
Mailing Address - Fax:956-620-3139
Practice Address - Street 1:155 UPTOWN AVE STE B
Practice Address - Street 2:
Practice Address - City:BROWNSVILLE
Practice Address - State:TX
Practice Address - Zip Code:78520-7568
Practice Address - Country:US
Practice Address - Phone:956-620-3140
Practice Address - Fax:956-620-3139
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-12-01
Last Update Date:2022-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
No261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary CareGroup - Multi-Specialty