Provider Demographics
NPI:1699199653
Name:PALOMITA PROVIDER SERVICE, LLC
Entity Type:Organization
Organization Name:PALOMITA PROVIDER SERVICE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:EUNICE
Authorized Official - Middle Name:
Authorized Official - Last Name:VASQUEZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:956-645-7293
Mailing Address - Street 1:2101 CHIHUAHUA ST
Mailing Address - Street 2:STE. 107
Mailing Address - City:LAREDO
Mailing Address - State:TX
Mailing Address - Zip Code:78043-3639
Mailing Address - Country:US
Mailing Address - Phone:956-518-0088
Mailing Address - Fax:
Practice Address - Street 1:815 SALINAS AVE STE B
Practice Address - Street 2:
Practice Address - City:LAREDO
Practice Address - State:TX
Practice Address - Zip Code:78040-8007
Practice Address - Country:US
Practice Address - Phone:956-518-0088
Practice Address - Fax:956-272-0108
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-02-11
Last Update Date:2023-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care