Provider Demographics
NPI:1164280319
Name:C & C VITALITY HEALTH-TEXAS LLC
Entity Type:Organization
Organization Name:C & C VITALITY HEALTH-TEXAS LLC
Other - Org Name:CLINICA FAMILIAR ESMERALDA
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:RAUL
Authorized Official - Middle Name:
Authorized Official - Last Name:HERNANDEZ CANETE
Authorized Official - Suffix:
Authorized Official - Credentials:APRN
Authorized Official - Phone:832-960-1233
Mailing Address - Street 1:2501 AVENUE J STE 135
Mailing Address - Street 2:
Mailing Address - City:ARLINGTON
Mailing Address - State:TX
Mailing Address - Zip Code:76006-6227
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2501 AVENUE J STE 135
Practice Address - Street 2:
Practice Address - City:ARLINGTON
Practice Address - State:TX
Practice Address - Zip Code:76006-6227
Practice Address - Country:US
Practice Address - Phone:832-960-1233
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
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Single Specialty