Provider Demographics
NPI:1942788849
Name:BIENESTAR HEALTH CLINIC
Entity Type:Organization
Organization Name:BIENESTAR HEALTH CLINIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/COMPANY ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:ROSA
Authorized Official - Middle Name:ANA
Authorized Official - Last Name:RODRIGUEZ
Authorized Official - Suffix:
Authorized Official - Credentials:FNP
Authorized Official - Phone:956-568-7803
Mailing Address - Street 1:1220 SAN AGUSTIN AVE
Mailing Address - Street 2:
Mailing Address - City:LAREDO
Mailing Address - State:TX
Mailing Address - Zip Code:78040-6307
Mailing Address - Country:US
Mailing Address - Phone:956-568-7803
Mailing Address - Fax:956-568-7804
Practice Address - Street 1:1220 SAN AGUSTIN AVE
Practice Address - Street 2:
Practice Address - City:LAREDO
Practice Address - State:TX
Practice Address - Zip Code:78040
Practice Address - Country:US
Practice Address - Phone:956-568-7803
Practice Address - Fax:956-568-7804
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-08-02
Last Update Date:2018-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Single Specialty