Provider Demographics
NPI:1780712620
Name:ABREU ADULT CLINIC P A
Entity type:Organization
Organization Name:ABREU ADULT CLINIC P A
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:CHARITY
Authorized Official - Middle Name:VIRGINIA
Authorized Official - Last Name:ABREU-LAWRENCE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:956-581-0539
Mailing Address - Street 1:910 S BRYAN RD
Mailing Address - Street 2:SUITE 105
Mailing Address - City:MISSION
Mailing Address - State:TX
Mailing Address - Zip Code:78572-6658
Mailing Address - Country:US
Mailing Address - Phone:956-581-0539
Mailing Address - Fax:956-323-1499
Practice Address - Street 1:910 S BRYAN RD STE 105
Practice Address - Street 2:
Practice Address - City:MISSION
Practice Address - State:TX
Practice Address - Zip Code:78572-6615
Practice Address - Country:US
Practice Address - Phone:956-581-0539
Practice Address - Fax:956-585-0745
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-01
Last Update Date:2023-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXJ8856207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX096777002Medicaid
TX096777002Medicaid
TXG13960Medicare UPIN