Provider Demographics
NPI:1396180683
Name:POLICLINICA BIENESTAR LATINA LLC
Entity Type:Organization
Organization Name:POLICLINICA BIENESTAR LATINA LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:ALFREDO
Authorized Official - Middle Name:A
Authorized Official - Last Name:GONZALES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:713-370-2260
Mailing Address - Street 1:6633 HILLCROFT ST
Mailing Address - Street 2:SUITE 261
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77081-4887
Mailing Address - Country:US
Mailing Address - Phone:713-370-2260
Mailing Address - Fax:
Practice Address - Street 1:6633 HILLCROFT ST
Practice Address - Street 2:SUITE 261
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77081-4887
Practice Address - Country:US
Practice Address - Phone:713-370-2260
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-05-01
Last Update Date:2013-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXP1754261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center