Provider Demographics
NPI:1114944923
Name:LAS COLINAS MEDICAL GROUP, INC.
Entity Type:Organization
Organization Name:LAS COLINAS MEDICAL GROUP, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:M.D.
Authorized Official - Prefix:MR
Authorized Official - First Name:ALFREDO
Authorized Official - Middle Name:
Authorized Official - Last Name:RAMIREZ
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:408-729-2900
Mailing Address - Street 1:2820 ALUM ROCK AVE STE 20
Mailing Address - Street 2:
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95127-5608
Mailing Address - Country:US
Mailing Address - Phone:408-729-2900
Mailing Address - Fax:408-254-9090
Practice Address - Street 1:2820 ALUM ROCK AVE STE 20
Practice Address - Street 2:
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95127-5608
Practice Address - Country:US
Practice Address - Phone:408-729-2900
Practice Address - Fax:408-254-9090
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-16
Last Update Date:2014-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA33235261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAGR0060780Medicaid
MM00226MMedicare ID - Type Unspecified