Provider Demographics
NPI:1679356182
Name:CLINICA BIENESTAR FAMILIAR LLC
Entity Type:Organization
Organization Name:CLINICA BIENESTAR FAMILIAR LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/FNP
Authorized Official - Prefix:
Authorized Official - First Name:ANTONIO
Authorized Official - Middle Name:
Authorized Official - Last Name:BRIZUELA
Authorized Official - Suffix:
Authorized Official - Credentials:FNP
Authorized Official - Phone:214-497-7346
Mailing Address - Street 1:630 N O CONNOR RD
Mailing Address - Street 2:
Mailing Address - City:IRVING
Mailing Address - State:TX
Mailing Address - Zip Code:75061-7530
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:630 N O CONNOR RD
Practice Address - Street 2:
Practice Address - City:IRVING
Practice Address - State:TX
Practice Address - Zip Code:75061-7530
Practice Address - Country:US
Practice Address - Phone:469-565-2544
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-08-17
Last Update Date:2023-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Multi-Specialty