Provider Demographics
NPI:1710230065
Name:ST FAMILY CLINIC INC
Entity Type:Organization
Organization Name:ST FAMILY CLINIC INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:ENGRACIA
Authorized Official - Middle Name:DEL ROCIO
Authorized Official - Last Name:VAZQUEZ
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:915-599-9993
Mailing Address - Street 1:1470 GEORGE DIETER DR
Mailing Address - Street 2:SUITE F
Mailing Address - City:EL PASO
Mailing Address - State:TX
Mailing Address - Zip Code:79936-7678
Mailing Address - Country:US
Mailing Address - Phone:915-599-9993
Mailing Address - Fax:915-599-9050
Practice Address - Street 1:1470 GEORGE DIETER DR
Practice Address - Street 2:SUITE F
Practice Address - City:EL PASO
Practice Address - State:TX
Practice Address - Zip Code:79936-7678
Practice Address - Country:US
Practice Address - Phone:915-599-9993
Practice Address - Fax:915-599-9050
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-10-24
Last Update Date:2012-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX614032261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX614032Other614032 TX RN NUMBER