Provider Demographics
NPI:1740301985
Name:LA JOYA'S NEIGHBORHOOD DOCTOR, P.A.
Entity type:Organization
Organization Name:LA JOYA'S NEIGHBORHOOD DOCTOR, P.A.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:HECTOR
Authorized Official - Middle Name:M
Authorized Official - Last Name:SALAS
Authorized Official - Suffix:
Authorized Official - Credentials:BS
Authorized Official - Phone:956-583-2300
Mailing Address - Street 1:2121 E GRIFFIN PKWY
Mailing Address - Street 2:STE 6
Mailing Address - City:MISSION
Mailing Address - State:TX
Mailing Address - Zip Code:78572-3241
Mailing Address - Country:US
Mailing Address - Phone:956-583-2300
Mailing Address - Fax:956-583-2295
Practice Address - Street 1:2121 E GRIFFIN PKWY
Practice Address - Street 2:STE 6
Practice Address - City:MISSION
Practice Address - State:TX
Practice Address - Zip Code:78572-3072
Practice Address - Country:US
Practice Address - Phone:956-583-2300
Practice Address - Fax:956-583-2295
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-03
Last Update Date:2009-05-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXJ8951207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXDC3174OtherRR MEDICARE
TX092247801Medicaid
TX0077CVOtherBCBS
TX0077CVOtherBCBS