Provider Demographics
NPI:1912194648
Name:WELL CARE OCCUPATIONAL CLINICS PA
Entity Type:Organization
Organization Name:WELL CARE OCCUPATIONAL CLINICS PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/MEDICAL DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:LUIS
Authorized Official - Middle Name:EDUARDO
Authorized Official - Last Name:LEYTON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:361-851-9500
Mailing Address - Street 1:PO BOX 1071
Mailing Address - Street 2:
Mailing Address - City:HARLINGEN
Mailing Address - State:TX
Mailing Address - Zip Code:78551-1071
Mailing Address - Country:US
Mailing Address - Phone:956-423-2504
Mailing Address - Fax:956-423-2027
Practice Address - Street 1:5502 SAN BERNARDO AVE
Practice Address - Street 2:STE. 600
Practice Address - City:LAREDO
Practice Address - State:TX
Practice Address - Zip Code:78041-3008
Practice Address - Country:US
Practice Address - Phone:956-728-9979
Practice Address - Fax:956-728-9980
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-09-26
Last Update Date:2007-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Multi-Specialty