Provider Demographics
NPI:1871287094
Name:CENTRO MEDICO INTEGRAL HISPANO LLC
Entity type:Organization
Organization Name:CENTRO MEDICO INTEGRAL HISPANO LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:AUTHORIZE OFFICIAL/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ROSELIO
Authorized Official - Middle Name:
Authorized Official - Last Name:PEREZ GARCIA
Authorized Official - Suffix:
Authorized Official - Credentials:FNP
Authorized Official - Phone:214-647-1165
Mailing Address - Street 1:2110 N GALLOWAY AVE STE 108
Mailing Address - Street 2:
Mailing Address - City:MESQUITE
Mailing Address - State:TX
Mailing Address - Zip Code:75150-5779
Mailing Address - Country:US
Mailing Address - Phone:305-539-8084
Mailing Address - Fax:
Practice Address - Street 1:2110 N GALLOWAY AVE STE 108
Practice Address - Street 2:
Practice Address - City:MESQUITE
Practice Address - State:TX
Practice Address - Zip Code:75150-5779
Practice Address - Country:US
Practice Address - Phone:305-539-8084
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-06-08
Last Update Date:2023-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Single Specialty