Provider Demographics
NPI:1376138271
Name:CLINICA GLORIA DE AMERICA
Entity Type:Organization
Organization Name:CLINICA GLORIA DE AMERICA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:LLENISSET
Authorized Official - Middle Name:
Authorized Official - Last Name:ARCIA-DIAZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:832-299-6144
Mailing Address - Street 1:25188 INTERSTATE 45 N STE 1G
Mailing Address - Street 2:
Mailing Address - City:SPRING
Mailing Address - State:TX
Mailing Address - Zip Code:77386-1453
Mailing Address - Country:US
Mailing Address - Phone:832-299-6144
Mailing Address - Fax:832-299-6155
Practice Address - Street 1:25188 INTERSTATE 45 N STE 1G
Practice Address - Street 2:
Practice Address - City:SPRING
Practice Address - State:TX
Practice Address - Zip Code:77386-1453
Practice Address - Country:US
Practice Address - Phone:832-299-6144
Practice Address - Fax:832-299-6155
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-03-03
Last Update Date:2021-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty