Provider Demographics
NPI:1922478775
Name:CLINICA UNIVERSO LATINO 2 LLC
Entity Type:Organization
Organization Name:CLINICA UNIVERSO LATINO 2 LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:CHIKA
Authorized Official - Middle Name:
Authorized Official - Last Name:ODILI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:832-602-9576
Mailing Address - Street 1:112 AVENUE F
Mailing Address - Street 2:
Mailing Address - City:STAFFORD
Mailing Address - State:TX
Mailing Address - Zip Code:77477-5502
Mailing Address - Country:US
Mailing Address - Phone:832-602-9576
Mailing Address - Fax:
Practice Address - Street 1:112 AVENUE F
Practice Address - Street 2:
Practice Address - City:STAFFORD
Practice Address - State:TX
Practice Address - Zip Code:77477-5502
Practice Address - Country:US
Practice Address - Phone:832-602-9576
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-10-05
Last Update Date:2015-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center