Provider Demographics
NPI:1770860116
Name:CLINICA SAGRADO CORAZON
Entity Type:Organization
Organization Name:CLINICA SAGRADO CORAZON
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:PABLO
Authorized Official - Middle Name:
Authorized Official - Last Name:OLMEDO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:956-580-2145
Mailing Address - Street 1:3401 W MILE 5 RD STE 1
Mailing Address - Street 2:
Mailing Address - City:MISSION
Mailing Address - State:TX
Mailing Address - Zip Code:78574-5177
Mailing Address - Country:US
Mailing Address - Phone:956-778-2032
Mailing Address - Fax:956-580-2677
Practice Address - Street 1:3401 W MILE 5 RD STE 1
Practice Address - Street 2:
Practice Address - City:MISSION
Practice Address - State:TX
Practice Address - Zip Code:78574-5177
Practice Address - Country:US
Practice Address - Phone:956-778-2032
Practice Address - Fax:956-580-2677
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-11-14
Last Update Date:2014-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXM8225261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center