Provider Demographics
NPI:1073657516
Name:EL MILAGRO
Entity Type:Organization
Organization Name:EL MILAGRO
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ELIDIA
Authorized Official - Middle Name:Z
Authorized Official - Last Name:FERRETIZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:956-542-7411
Mailing Address - Street 1:4700 YOUNG DRIVE
Mailing Address - Street 2:
Mailing Address - City:BROWNSVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:78520
Mailing Address - Country:US
Mailing Address - Phone:956-542-7411
Mailing Address - Fax:956-542-7433
Practice Address - Street 1:644 PALM BLVD
Practice Address - Street 2:
Practice Address - City:BROWNSVILLE
Practice Address - State:TX
Practice Address - Zip Code:78520-6115
Practice Address - Country:US
Practice Address - Phone:956-542-7411
Practice Address - Fax:956-542-7433
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-17
Last Update Date:2008-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX118064261QA0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA0600XAmbulatory Health Care FacilitiesClinic/CenterAdult Day Care