Provider Demographics
NPI:1508558651
Name:COUNTY OF LA SALLE
Entity Type:Organization
Organization Name:COUNTY OF LA SALLE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:COUNTY JUDGE
Authorized Official - Prefix:
Authorized Official - First Name:LEODORO
Authorized Official - Middle Name:
Authorized Official - Last Name:MARTINEZ
Authorized Official - Suffix:III
Authorized Official - Credentials:
Authorized Official - Phone:830-483-5139
Mailing Address - Street 1:300 SANTANA ROW STE 300
Mailing Address - Street 2:
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95128-2424
Mailing Address - Country:US
Mailing Address - Phone:669-236-5953
Mailing Address - Fax:
Practice Address - Street 1:627 N BAYLOR ST
Practice Address - Street 2:
Practice Address - City:COTULLA
Practice Address - State:TX
Practice Address - Zip Code:78014
Practice Address - Country:US
Practice Address - Phone:830-483-5260
Practice Address - Fax:830-483-5865
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-05-25
Last Update Date:2023-05-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QE0700XAmbulatory Health Care FacilitiesClinic/CenterEnd-Stage Renal Disease (ESRD) Treatment
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX110680OtherTX HHSC STATE LICENSE