Provider Demographics
NPI:1609024108
Name:M & M SOUTH AT CLINICA SANTA MARIA, LLP
Entity Type:Organization
Organization Name:M & M SOUTH AT CLINICA SANTA MARIA, LLP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MD/PARTNER
Authorized Official - Prefix:
Authorized Official - First Name:MIR
Authorized Official - Middle Name:S
Authorized Official - Last Name:ALI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:956-465-1193
Mailing Address - Street 1:3855 SOUTHMOST RD FL 2
Mailing Address - Street 2:
Mailing Address - City:BROWNSVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:78521-4863
Mailing Address - Country:US
Mailing Address - Phone:956-465-1193
Mailing Address - Fax:
Practice Address - Street 1:1474 W PRICE RD # 602
Practice Address - Street 2:
Practice Address - City:BROWNSVILLE
Practice Address - State:TX
Practice Address - Zip Code:78520-8687
Practice Address - Country:US
Practice Address - Phone:956-465-1193
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-09-09
Last Update Date:2008-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX193983701Medicaid