Provider Demographics
NPI:1417305202
Name:CRYSTAL PRIMARY CARE, LLC
Entity Type:Organization
Organization Name:CRYSTAL PRIMARY CARE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:OSEAS
Authorized Official - Middle Name:
Authorized Official - Last Name:GOMEZ
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:956-251-7919
Mailing Address - Street 1:315 CALLE DEL NORTE STE 203
Mailing Address - Street 2:
Mailing Address - City:LAREDO
Mailing Address - State:TX
Mailing Address - Zip Code:78041-5961
Mailing Address - Country:US
Mailing Address - Phone:956-568-2240
Mailing Address - Fax:956-568-1860
Practice Address - Street 1:315 CALLE DEL NORTE STE 203
Practice Address - Street 2:
Practice Address - City:LAREDO
Practice Address - State:TX
Practice Address - Zip Code:78041-5961
Practice Address - Country:US
Practice Address - Phone:956-568-2240
Practice Address - Fax:956-568-1860
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-06-02
Last Update Date:2024-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health