Provider Demographics
NPI:1619026911
Name:LEONA STREET HOLDINGS I, LLC
Entity Type:Organization
Organization Name:LEONA STREET HOLDINGS I, LLC
Other - Org Name:ROGELIO E. RAMIREZ
Other - Org Type:Other Name
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:DR
Authorized Official - First Name:ROGELIO
Authorized Official - Middle Name:ESQUIVEL
Authorized Official - Last Name:RAMIREZ
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:830-278-4880
Mailing Address - Street 1:119 E LEONA ST
Mailing Address - Street 2:
Mailing Address - City:UVALDE
Mailing Address - State:TX
Mailing Address - Zip Code:78801-4740
Mailing Address - Country:US
Mailing Address - Phone:830-278-4880
Mailing Address - Fax:830-278-4883
Practice Address - Street 1:119 E LEONA ST
Practice Address - Street 2:
Practice Address - City:UVALDE
Practice Address - State:TX
Practice Address - Zip Code:78801-4740
Practice Address - Country:US
Practice Address - Phone:830-278-4880
Practice Address - Fax:830-278-4883
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-09
Last Update Date:2008-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXDC6249111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX00X864OtherMEDICARE PTAN
TX0089NPOtherBCBS
TX192937401Medicaid
TX47786Medicare UPIN