Provider Demographics
NPI:1174759591
Name:ELSIE N LA TEXERA CSP
Entity type:Organization
Organization Name:ELSIE N LA TEXERA CSP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OPTOMETRIST OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ELSIE
Authorized Official - Middle Name:N
Authorized Official - Last Name:DE LA TEXERA
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:787-735-7119
Mailing Address - Street 1:TORRE MED SAN LUCAS
Mailing Address - Street 2:AVENIDA TITO CASTRO SUITE 125
Mailing Address - City:PONCE
Mailing Address - State:PR
Mailing Address - Zip Code:00716-4728
Mailing Address - Country:US
Mailing Address - Phone:787-651-1424
Mailing Address - Fax:
Practice Address - Street 1:TORRE MED SAN LUCAS
Practice Address - Street 2:AVENIDA TITO CASTRO SUITE 125
Practice Address - City:PONCE
Practice Address - State:PR
Practice Address - Zip Code:00716-4728
Practice Address - Country:US
Practice Address - Phone:787-651-1424
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-06-01
Last Update Date:2009-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center