Provider Demographics
NPI:1881048049
Name:CLINICA EMMANUEL NINOS Y ADULTOS LLC
Entity type:Organization
Organization Name:CLINICA EMMANUEL NINOS Y ADULTOS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:AGUSTIN
Authorized Official - Middle Name:B
Authorized Official - Last Name:MEGO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:956-580-9071
Mailing Address - Street 1:PO BOX 787
Mailing Address - Street 2:
Mailing Address - City:MISSION
Mailing Address - State:TX
Mailing Address - Zip Code:78573-0013
Mailing Address - Country:US
Mailing Address - Phone:956-580-9071
Mailing Address - Fax:956-580-9087
Practice Address - Street 1:9927 STATE HIGHWAY 107
Practice Address - Street 2:
Practice Address - City:MISSION
Practice Address - State:TX
Practice Address - Zip Code:78573-7860
Practice Address - Country:US
Practice Address - Phone:956-580-9071
Practice Address - Fax:956-580-9087
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-04-14
Last Update Date:2024-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty