Provider Demographics
NPI:1164280244
Name:CLINICA HF JUPITER LLC
Entity Type:Organization
Organization Name:CLINICA HF JUPITER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MARSEL
Authorized Official - Middle Name:
Authorized Official - Last Name:YOUSEF
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:469-304-0074
Mailing Address - Street 1:3516 W WALNUT ST
Mailing Address - Street 2:
Mailing Address - City:GARLAND
Mailing Address - State:TX
Mailing Address - Zip Code:75042-6234
Mailing Address - Country:US
Mailing Address - Phone:469-304-0074
Mailing Address - Fax:
Practice Address - Street 1:3516 W WALNUT ST
Practice Address - Street 2:
Practice Address - City:GARLAND
Practice Address - State:TX
Practice Address - Zip Code:75042-6234
Practice Address - Country:US
Practice Address - Phone:469-304-0074
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-03-12
Last Update Date:2024-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty