Provider Demographics
NPI:1225342934
Name:REBECCA N CONTRERAS
Entity Type:Organization
Organization Name:REBECCA N CONTRERAS
Other - Org Name:VIDA ABUNDANTE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER/ADMINISTRATOR
Authorized Official - Prefix:MS
Authorized Official - First Name:REBECCA
Authorized Official - Middle Name:N
Authorized Official - Last Name:CONTRERAS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:956-331-9108
Mailing Address - Street 1:PO BOX 1190
Mailing Address - Street 2:
Mailing Address - City:PENITAS
Mailing Address - State:TX
Mailing Address - Zip Code:78576-1190
Mailing Address - Country:US
Mailing Address - Phone:956-331-9108
Mailing Address - Fax:956-584-3764
Practice Address - Street 1:701 TOM GILL RD
Practice Address - Street 2:
Practice Address - City:PENITAS
Practice Address - State:TX
Practice Address - Zip Code:78576
Practice Address - Country:US
Practice Address - Phone:956-331-9108
Practice Address - Fax:956-584-3764
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-08-05
Last Update Date:2010-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX261QA0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA0600XAmbulatory Health Care FacilitiesClinic/CenterAdult Day Care