Provider Demographics
NPI:1275996860
Name:DOORSTEP PROCARE MANAGEMENT LLC
Entity Type:Organization
Organization Name:DOORSTEP PROCARE MANAGEMENT LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING MEMBER
Authorized Official - Prefix:MR
Authorized Official - First Name:JESSIE
Authorized Official - Middle Name:GARZON
Authorized Official - Last Name:MENDIOLA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:469-438-4493
Mailing Address - Street 1:12035 SHILOH RD STE 310
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75228-1507
Mailing Address - Country:US
Mailing Address - Phone:972-289-2273
Mailing Address - Fax:972-285-1396
Practice Address - Street 1:2944 MOTLEY DR STE 401
Practice Address - Street 2:
Practice Address - City:MESQUITE
Practice Address - State:TX
Practice Address - Zip Code:75150-3464
Practice Address - Country:US
Practice Address - Phone:972-289-2273
Practice Address - Fax:972-439-1776
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-03-31
Last Update Date:2023-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX3633174Medicaid