Provider Demographics
NPI:1043465081
Name:CENTRO DE MI SALUD
Entity type:Organization
Organization Name:CENTRO DE MI SALUD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:QMHP
Authorized Official - Prefix:MS
Authorized Official - First Name:NAOMI
Authorized Official - Middle Name:
Authorized Official - Last Name:GUZMAN
Authorized Official - Suffix:
Authorized Official - Credentials:MSSW
Authorized Official - Phone:214-941-0798
Mailing Address - Street 1:1931 AMERIGO
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75211
Mailing Address - Country:US
Mailing Address - Phone:214-941-0798
Mailing Address - Fax:214-941-0408
Practice Address - Street 1:628 CENTRE ST
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75208-6328
Practice Address - Country:US
Practice Address - Phone:214-941-0798
Practice Address - Fax:214-941-0408
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-11-18
Last Update Date:2008-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1043204019Medicaid