Provider Demographics
NPI:1801233200
Name:SOUTH TEXAS FAMILY CLINIC OF LAREDO
Entity Type:Organization
Organization Name:SOUTH TEXAS FAMILY CLINIC OF LAREDO
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:FAMILY NURSE PRACTITIONER
Authorized Official - Prefix:
Authorized Official - First Name:SANDRA
Authorized Official - Middle Name:
Authorized Official - Last Name:RODRIGUEZ
Authorized Official - Suffix:
Authorized Official - Credentials:FNP
Authorized Official - Phone:956-489-0098
Mailing Address - Street 1:3914 RASOUL DR
Mailing Address - Street 2:
Mailing Address - City:LAREDO
Mailing Address - State:TX
Mailing Address - Zip Code:78045-4503
Mailing Address - Country:US
Mailing Address - Phone:956-489-0098
Mailing Address - Fax:
Practice Address - Street 1:3914 RASOUL DR
Practice Address - Street 2:
Practice Address - City:LAREDO
Practice Address - State:TX
Practice Address - Zip Code:78045-4503
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:2013-05-27
Last Update Date:2013-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX669287261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center