Provider Demographics
NPI:1407490196
Name:DIVINE FAMILY CARE PLLC
Entity Type:Organization
Organization Name:DIVINE FAMILY CARE PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:DIEGO
Authorized Official - Middle Name:
Authorized Official - Last Name:NARANJO
Authorized Official - Suffix:
Authorized Official - Credentials:APRN
Authorized Official - Phone:956-592-1311
Mailing Address - Street 1:832 ABRAHAMSON DR
Mailing Address - Street 2:
Mailing Address - City:BROWNSVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:78526-9469
Mailing Address - Country:US
Mailing Address - Phone:956-592-1311
Mailing Address - Fax:
Practice Address - Street 1:222 N EXPRESSWAY # 83
Practice Address - Street 2:
Practice Address - City:BROWNSVILLE
Practice Address - State:TX
Practice Address - Zip Code:78521-2258
Practice Address - Country:US
Practice Address - Phone:956-592-1311
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-11-05
Last Update Date:2019-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGroup - Single Specialty