Provider Demographics
NPI:1497803449
Name:SUCLINICA FAMILIAR
Entity Type:Organization
Organization Name:SUCLINICA FAMILIAR
Other - Org Name:SU CLINICA FAMILIAR DENTAL CSHCN
Other - Org Type:Other Name
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:MR
Authorized Official - First Name:ADAM
Authorized Official - Middle Name:
Authorized Official - Last Name:SALDIVAR
Authorized Official - Suffix:
Authorized Official - Credentials:CFO
Authorized Official - Phone:956-365-6750
Mailing Address - Street 1:1706 TREASURE HILLS BLVD
Mailing Address - Street 2:
Mailing Address - City:HARLINGEN
Mailing Address - State:TX
Mailing Address - Zip Code:78550-8911
Mailing Address - Country:US
Mailing Address - Phone:956-365-6750
Mailing Address - Fax:956-365-6779
Practice Address - Street 1:1706 TREASURE HILLS BLVD
Practice Address - Street 2:
Practice Address - City:HARLINGEN
Practice Address - State:TX
Practice Address - Zip Code:78550-8911
Practice Address - Country:US
Practice Address - Phone:956-365-6750
Practice Address - Fax:956-365-6779
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-08
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental
Not Answered261QF0400XAmbulatory Health Care FacilitiesClinic/CenterFederally Qualified Health Center (FQHC)