Provider Demographics
NPI:1013443373
Name:FIESTA PRIMARY HOME CARE, LLC
Entity Type:Organization
Organization Name:FIESTA PRIMARY HOME CARE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:SAUL
Authorized Official - Middle Name:HECTOR
Authorized Official - Last Name:ZAMBRANO
Authorized Official - Suffix:JR
Authorized Official - Credentials:
Authorized Official - Phone:956-602-0275
Mailing Address - Street 1:6508 N BARTLETT AVE STE E
Mailing Address - Street 2:
Mailing Address - City:LAREDO
Mailing Address - State:TX
Mailing Address - Zip Code:78041-6446
Mailing Address - Country:US
Mailing Address - Phone:956-602-0275
Mailing Address - Fax:
Practice Address - Street 1:6508 N BARTLETT AVE STE D
Practice Address - Street 2:
Practice Address - City:LAREDO
Practice Address - State:TX
Practice Address - Zip Code:78041-6446
Practice Address - Country:US
Practice Address - Phone:956-602-0275
Practice Address - Fax:956-666-7485
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-05-05
Last Update Date:2024-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care AttendantGroup - Multi-Specialty
No251C00000XAgenciesDay Training, Developmentally Disabled Services
No251J00000XAgenciesNursing CareGroup - Multi-Specialty
No253Z00000XAgenciesIn Home Supportive CareGroup - Multi-Specialty
No374U00000XNursing Service Related ProvidersHome Health AideGroup - Multi-Specialty