Provider Demographics
NPI:1417713942
Name:LA CASA FAMILY PRACTICE PLLC
Entity Type:Organization
Organization Name:LA CASA FAMILY PRACTICE PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MILDREY
Authorized Official - Middle Name:
Authorized Official - Last Name:MARTINEZ
Authorized Official - Suffix:
Authorized Official - Credentials:APRN
Authorized Official - Phone:561-236-7585
Mailing Address - Street 1:1127 ROYAL PALM BEACH BLVD PMB 138
Mailing Address - Street 2:
Mailing Address - City:ROYAL PALM BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33411-1641
Mailing Address - Country:US
Mailing Address - Phone:561-236-7585
Mailing Address - Fax:
Practice Address - Street 1:13373 KINGSBURY DR
Practice Address - Street 2:
Practice Address - City:WELLINGTON
Practice Address - State:FL
Practice Address - Zip Code:33414-3923
Practice Address - Country:US
Practice Address - Phone:561-236-7585
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-02-22
Last Update Date:2024-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGroup - Multi-Specialty