Provider Demographics
NPI:1497577092
Name:CLINICA HISPANA VILLA SALUD LLC
Entity type:Organization
Organization Name:CLINICA HISPANA VILLA SALUD LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:ERNESTO
Authorized Official - Middle Name:RAMON
Authorized Official - Last Name:BRUZON INFANTES
Authorized Official - Suffix:
Authorized Official - Credentials:NP
Authorized Official - Phone:786-357-3719
Mailing Address - Street 1:6955 GULF FWY
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77087-2512
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:6955 GULF FWY
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77087-2512
Practice Address - Country:US
Practice Address - Phone:713-347-9750
Practice Address - Fax:713-424-2943
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-10-26
Last Update Date:2025-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty