Provider Demographics
NPI:1851639090
Name:LA FERIA HEALTH GROUP
Entity Type:Organization
Organization Name:LA FERIA HEALTH GROUP
Other - Org Name:LA FERIA CHILDRENS CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:M.D.
Authorized Official - Prefix:DR
Authorized Official - First Name:OMAR
Authorized Official - Middle Name:J
Authorized Official - Last Name:PENA-LOPEZ
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:917-498-4825
Mailing Address - Street 1:1403 CARNELIAN DR
Mailing Address - Street 2:
Mailing Address - City:WESLACO
Mailing Address - State:TX
Mailing Address - Zip Code:78596-4388
Mailing Address - Country:US
Mailing Address - Phone:917-498-4825
Mailing Address - Fax:
Practice Address - Street 1:1403 CARNELIAN DR
Practice Address - Street 2:
Practice Address - City:WESLACO
Practice Address - State:TX
Practice Address - Zip Code:78596-4388
Practice Address - Country:US
Practice Address - Phone:917-498-4825
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-01-23
Last Update Date:2013-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXN1058208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty