Provider Demographics
NPI:1790556710
Name:CLINICA LATINA FAMILIAR 1 LLC
Entity Type:Organization
Organization Name:CLINICA LATINA FAMILIAR 1 LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL PROVIDER
Authorized Official - Prefix:
Authorized Official - First Name:MAYDELIS
Authorized Official - Middle Name:
Authorized Official - Last Name:SUAREZ
Authorized Official - Suffix:
Authorized Official - Credentials:FNP
Authorized Official - Phone:386-205-4365
Mailing Address - Street 1:31315 FM 2920 RD STE 9
Mailing Address - Street 2:
Mailing Address - City:WALLER
Mailing Address - State:TX
Mailing Address - Zip Code:77484-8021
Mailing Address - Country:US
Mailing Address - Phone:936-372-3000
Mailing Address - Fax:936-372-3009
Practice Address - Street 1:31315 FM 2920 RD STE 9
Practice Address - Street 2:
Practice Address - City:WALLER
Practice Address - State:TX
Practice Address - Zip Code:77484-8021
Practice Address - Country:US
Practice Address - Phone:936-372-3000
Practice Address - Fax:936-372-3009
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-01-09
Last Update Date:2024-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Multi-Specialty