Provider Demographics
NPI:1134471394
Name:TEXAS PRN
Entity Type:Organization
Organization Name:TEXAS PRN
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:SIXTA
Authorized Official - Middle Name:MONICA
Authorized Official - Last Name:GUMATO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:432-558-2223
Mailing Address - Street 1:2020 E 8TH ST
Mailing Address - Street 2:
Mailing Address - City:ODESSA
Mailing Address - State:TX
Mailing Address - Zip Code:79761-4204
Mailing Address - Country:US
Mailing Address - Phone:432-558-2223
Mailing Address - Fax:
Practice Address - Street 1:2020 E 8TH ST
Practice Address - Street 2:
Practice Address - City:ODESSA
Practice Address - State:TX
Practice Address - Zip Code:79761-4204
Practice Address - Country:US
Practice Address - Phone:432-558-2223
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-10-11
Last Update Date:2012-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251J00000XAgenciesNursing Care