Provider Demographics
NPI:1821351958
Name:OGP HEALTHCARE, INC.
Entity Type:Organization
Organization Name:OGP HEALTHCARE, INC.
Other - Org Name:SANTA MARIA DE GUADALUPE CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:OLIVA
Authorized Official - Middle Name:G
Authorized Official - Last Name:PACANA
Authorized Official - Suffix:
Authorized Official - Credentials:FNP-BC
Authorized Official - Phone:214-679-4475
Mailing Address - Street 1:10818 NANTUCKET DR
Mailing Address - Street 2:
Mailing Address - City:ROWLETT
Mailing Address - State:TX
Mailing Address - Zip Code:75089-8468
Mailing Address - Country:US
Mailing Address - Phone:214-679-4475
Mailing Address - Fax:972-283-9104
Practice Address - Street 1:200 N CARRIER PKWY
Practice Address - Street 2:STE 100
Practice Address - City:GRAND PRAIRIE
Practice Address - State:TX
Practice Address - Zip Code:75050-5476
Practice Address - Country:US
Practice Address - Phone:214-679-4475
Practice Address - Fax:972-283-9104
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-06-22
Last Update Date:2013-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Single Specialty