Provider Demographics
NPI:1134694532
Name:NATIVIDAD WOUND CARE, LLC
Entity type:Organization
Organization Name:NATIVIDAD WOUND CARE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:SERGIO
Authorized Official - Middle Name:
Authorized Official - Last Name:ZAMORA
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:830-757-3900
Mailing Address - Street 1:138 ZAMORA MEDICAL CIR
Mailing Address - Street 2:
Mailing Address - City:EAGLE PASS
Mailing Address - State:TX
Mailing Address - Zip Code:78852-5924
Mailing Address - Country:US
Mailing Address - Phone:830-776-5486
Mailing Address - Fax:830-776-5590
Practice Address - Street 1:138 ZAMORA MEDICAL CIR
Practice Address - Street 2:
Practice Address - City:EAGLE PASS
Practice Address - State:TX
Practice Address - Zip Code:78852-5924
Practice Address - Country:US
Practice Address - Phone:830-776-5486
Practice Address - Fax:830-776-5590
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-10-11
Last Update Date:2021-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
No2083P0011XAllopathic & Osteopathic PhysiciansPreventive MedicineUndersea and Hyperbaric MedicineGroup - Single Specialty