Provider Demographics
NPI:1144561093
Name:CLINICA FAMILIAR HISPANA
Entity Type:Organization
Organization Name:CLINICA FAMILIAR HISPANA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCOTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:STANTON
Authorized Official - Middle Name:CLARK
Authorized Official - Last Name:PACKARD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:281-861-5565
Mailing Address - Street 1:17550 W LITTLE YORK RD
Mailing Address - Street 2:SUITE 10
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77084-6321
Mailing Address - Country:US
Mailing Address - Phone:281-861-5565
Mailing Address - Fax:281-861-4225
Practice Address - Street 1:17550 W LITTLE YORK RD
Practice Address - Street 2:SUITE 10
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77084-6321
Practice Address - Country:US
Practice Address - Phone:281-861-5565
Practice Address - Fax:281-861-4225
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-03-01
Last Update Date:2013-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXJ6641207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty