Provider Demographics
NPI:1952058315
Name:CLINICA FAMILIAR DICKINSON, LLC
Entity Type:Organization
Organization Name:CLINICA FAMILIAR DICKINSON, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:FNP
Authorized Official - Prefix:
Authorized Official - First Name:HUMBERTO
Authorized Official - Middle Name:
Authorized Official - Last Name:MARTINEZ
Authorized Official - Suffix:
Authorized Official - Credentials:NP-C
Authorized Official - Phone:512-701-5750
Mailing Address - Street 1:4913 FM 517 RD E
Mailing Address - Street 2:
Mailing Address - City:DICKINSON
Mailing Address - State:TX
Mailing Address - Zip Code:77539-6094
Mailing Address - Country:US
Mailing Address - Phone:832-340-7951
Mailing Address - Fax:832-340-7786
Practice Address - Street 1:4913 FM 517 RD E
Practice Address - Street 2:
Practice Address - City:DICKINSON
Practice Address - State:TX
Practice Address - Zip Code:77539-6094
Practice Address - Country:US
Practice Address - Phone:832-340-7951
Practice Address - Fax:832-340-7786
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-03-07
Last Update Date:2024-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary CareGroup - Single Specialty