Provider Demographics
NPI:1912655721
Name:CLINICA HISPANA DEL METROPLEX LLC
Entity Type:Organization
Organization Name:CLINICA HISPANA DEL METROPLEX LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:NP-C
Authorized Official - Prefix:
Authorized Official - First Name:YENNYS
Authorized Official - Middle Name:
Authorized Official - Last Name:RODRIGUEZ ALONSO
Authorized Official - Suffix:
Authorized Official - Credentials:APRN-CNP
Authorized Official - Phone:214-991-5536
Mailing Address - Street 1:2741 ELLIS AVE
Mailing Address - Street 2:
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76164-7131
Mailing Address - Country:US
Mailing Address - Phone:817-386-9926
Mailing Address - Fax:817-386-9907
Practice Address - Street 1:2741 ELLIS AVE
Practice Address - Street 2:
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76164-7131
Practice Address - Country:US
Practice Address - Phone:817-386-9926
Practice Address - Fax:817-386-9907
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-03-11
Last Update Date:2022-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care