Provider Demographics
NPI:1316188725
Name:COIMBRA, MARIA DE LOURDES M C (MD)
Entity Type:Individual
Prefix:
First Name:MARIA
Middle Name:DE LOURDES M C
Last Name:COIMBRA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2108 S M ST STE 3
Mailing Address - Street 2:
Mailing Address - City:MCALLEN
Mailing Address - State:TX
Mailing Address - Zip Code:78503-1556
Mailing Address - Country:US
Mailing Address - Phone:956-992-0660
Mailing Address - Fax:956-278-8128
Practice Address - Street 1:2108 S M ST STE 3
Practice Address - Street 2:
Practice Address - City:MCALLEN
Practice Address - State:TX
Practice Address - Zip Code:78503-1556
Practice Address - Country:US
Practice Address - Phone:956-992-0660
Practice Address - Fax:956-278-8128
Is Sole Proprietor?:Yes
Enumeration Date:2009-03-13
Last Update Date:2016-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXN2446207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX207750501Medicaid
TX207750501Medicaid