Provider Demographics
NPI:1700634672
Name:CLINICA FAMILIAR ALIANZA RE&BE LLC
Entity Type:Organization
Organization Name:CLINICA FAMILIAR ALIANZA RE&BE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:FNP
Authorized Official - Prefix:
Authorized Official - First Name:NIRLIAN
Authorized Official - Middle Name:
Authorized Official - Last Name:PORTIELES
Authorized Official - Suffix:
Authorized Official - Credentials:FNP
Authorized Official - Phone:713-589-7666
Mailing Address - Street 1:5444 FRY RD STE E
Mailing Address - Street 2:
Mailing Address - City:KATY
Mailing Address - State:TX
Mailing Address - Zip Code:77449-5597
Mailing Address - Country:US
Mailing Address - Phone:713-589-7666
Mailing Address - Fax:
Practice Address - Street 1:5444 FRY RD STE E
Practice Address - Street 2:
Practice Address - City:KATY
Practice Address - State:TX
Practice Address - Zip Code:77449-5597
Practice Address - Country:US
Practice Address - Phone:713-589-7666
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-05-07
Last Update Date:2024-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty