Provider Demographics
NPI:1811639982
Name:IZAGUIRREWC L L C
Entity type:Organization
Organization Name:IZAGUIRREWC L L C
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SOLE MEMBER /PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:SAUL
Authorized Official - Middle Name:
Authorized Official - Last Name:IZAGUIRRE
Authorized Official - Suffix:
Authorized Official - Credentials:NP
Authorized Official - Phone:956-648-2968
Mailing Address - Street 1:512 HUNEE DR
Mailing Address - Street 2:
Mailing Address - City:SAN JUAN
Mailing Address - State:TX
Mailing Address - Zip Code:78589-2755
Mailing Address - Country:US
Mailing Address - Phone:956-309-3290
Mailing Address - Fax:
Practice Address - Street 1:1110 S STEWART RD STE B
Practice Address - Street 2:
Practice Address - City:SAN JUAN
Practice Address - State:TX
Practice Address - Zip Code:78589-5206
Practice Address - Country:US
Practice Address - Phone:956-884-4550
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-04-10
Last Update Date:2025-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Multi-Specialty