Provider Demographics
NPI:1023533536
Name:COREAS FAMILY HEALTH CLINIC - LLC
Entity type:Organization
Organization Name:COREAS FAMILY HEALTH CLINIC - LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ARCENIO
Authorized Official - Middle Name:
Authorized Official - Last Name:COREA
Authorized Official - Suffix:
Authorized Official - Credentials:FNP
Authorized Official - Phone:210-730-1648
Mailing Address - Street 1:123 CORONADO AVE
Mailing Address - Street 2:
Mailing Address - City:LAREDO
Mailing Address - State:TX
Mailing Address - Zip Code:78043-4747
Mailing Address - Country:US
Mailing Address - Phone:210-730-1648
Mailing Address - Fax:
Practice Address - Street 1:1008 PASEO DE TIBER STE B
Practice Address - Street 2:
Practice Address - City:LAREDO
Practice Address - State:TX
Practice Address - Zip Code:78046-8939
Practice Address - Country:US
Practice Address - Phone:210-730-1648
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-08-04
Last Update Date:2017-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Single Specialty