Provider Demographics
NPI:1912677550
Name:HERMOSA VICTORIA PROVIDER AGENCY LLC
Entity Type:Organization
Organization Name:HERMOSA VICTORIA PROVIDER AGENCY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:JAVIER
Authorized Official - Middle Name:
Authorized Official - Last Name:HERNANDEZ
Authorized Official - Suffix:JR
Authorized Official - Credentials:
Authorized Official - Phone:956-321-9067
Mailing Address - Street 1:1960 ZENAIDA AVE
Mailing Address - Street 2:
Mailing Address - City:MCALLEN
Mailing Address - State:TX
Mailing Address - Zip Code:78504-5625
Mailing Address - Country:US
Mailing Address - Phone:956-321-9067
Mailing Address - Fax:956-992-1327
Practice Address - Street 1:2511 BUDDY OWENS AVE STE E
Practice Address - Street 2:
Practice Address - City:MCALLEN
Practice Address - State:TX
Practice Address - Zip Code:78504-5427
Practice Address - Country:US
Practice Address - Phone:956-321-9067
Practice Address - Fax:956-992-1327
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-09-15
Last Update Date:2022-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
No3747P1801XNursing Service Related ProvidersTechnicianPersonal Care AttendantGroup - Single Specialty