Provider Demographics
NPI:1811568546
Name:LUZ DE PADRES LLC
Entity Type:Organization
Organization Name:LUZ DE PADRES LLC
Other - Org Name:LUZ DE PADRES LLC
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:ALTERNATIVE ADMINSTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:PRISCILLA
Authorized Official - Middle Name:
Authorized Official - Last Name:PUENTE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:956-246-2446
Mailing Address - Street 1:222 N EXPRESSWAY 77/83 STE 157
Mailing Address - Street 2:
Mailing Address - City:BROWNSVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:78521-2258
Mailing Address - Country:US
Mailing Address - Phone:956-246-2446
Mailing Address - Fax:210-981-8535
Practice Address - Street 1:222 N EXPRESSWAY 77/83 STE 157
Practice Address - Street 2:
Practice Address - City:BROWNSVILLE
Practice Address - State:TX
Practice Address - Zip Code:78521-2258
Practice Address - Country:US
Practice Address - Phone:956-579-7263
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-07-04
Last Update Date:2022-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care AttendantGroup - Single Specialty