Provider Demographics
NPI:1700216132
Name:SOUTH LAREDO HEALTH CARE CLINIC
Entity Type:Organization
Organization Name:SOUTH LAREDO HEALTH CARE CLINIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:HECTOR
Authorized Official - Middle Name:EMILIO
Authorized Official - Last Name:GARCIA
Authorized Official - Suffix:
Authorized Official - Credentials:FNP
Authorized Official - Phone:956-286-6834
Mailing Address - Street 1:2110 LOMAS DEL SUR STE 103
Mailing Address - Street 2:
Mailing Address - City:LAREDO
Mailing Address - State:TX
Mailing Address - Zip Code:78046-5751
Mailing Address - Country:US
Mailing Address - Phone:956-489-0098
Mailing Address - Fax:
Practice Address - Street 1:2110 LOMAS DEL SUR STE 103
Practice Address - Street 2:
Practice Address - City:LAREDO
Practice Address - State:TX
Practice Address - Zip Code:78046-5751
Practice Address - Country:US
Practice Address - Phone:956-489-0098
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-11-21
Last Update Date:2013-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX653204261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center