Provider Demographics
NPI:1255693123
Name:HEALTHY FAMILY CLINIC LLC
Entity Type:Organization
Organization Name:HEALTHY FAMILY CLINIC LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:GRACE
Authorized Official - Middle Name:
Authorized Official - Last Name:GUERRERO
Authorized Official - Suffix:
Authorized Official - Credentials:FNP
Authorized Official - Phone:956-630-6111
Mailing Address - Street 1:1001 S 10TH ST
Mailing Address - Street 2:STE G 787
Mailing Address - City:MCALLEN
Mailing Address - State:TX
Mailing Address - Zip Code:78501-5049
Mailing Address - Country:US
Mailing Address - Phone:956-682-3600
Mailing Address - Fax:956-682-3609
Practice Address - Street 1:3900 W EXPRESSWAY 83
Practice Address - Street 2:
Practice Address - City:MCALLEN
Practice Address - State:TX
Practice Address - Zip Code:78501-8425
Practice Address - Country:US
Practice Address - Phone:956-682-3600
Practice Address - Fax:956-682-3609
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-06-15
Last Update Date:2012-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX2009008448363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Multi-Specialty