Provider Demographics
NPI:1255075362
Name:CENTER FOR HEALTH SERVICES,LLC
Entity type:Organization
Organization Name:CENTER FOR HEALTH SERVICES,LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:ALIESKI
Authorized Official - Middle Name:
Authorized Official - Last Name:MASTRAPA DOMINGUEZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:281-381-6190
Mailing Address - Street 1:PO BOX 2799
Mailing Address - Street 2:
Mailing Address - City:PORTER
Mailing Address - State:TX
Mailing Address - Zip Code:77365-2799
Mailing Address - Country:US
Mailing Address - Phone:281-381-6190
Mailing Address - Fax:
Practice Address - Street 1:818 MARTIN RD
Practice Address - Street 2:SUITE 3
Practice Address - City:AMARILLO
Practice Address - State:TX
Practice Address - Zip Code:77365
Practice Address - Country:US
Practice Address - Phone:806-418-4366
Practice Address - Fax:806-418-4365
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-04-25
Last Update Date:2023-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Multi-Specialty
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGroup - Multi-Specialty