Provider Demographics
NPI:1871776567
Name:LA PAZ COMMUNITY HEALTHCARE CENTER, INC
Entity type:Organization
Organization Name:LA PAZ COMMUNITY HEALTHCARE CENTER, INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:ADEDIRAN
Authorized Official - Middle Name:
Authorized Official - Last Name:ADEDEJI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:210-697-5700
Mailing Address - Street 1:530 SAN PEDRO AVE
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78212-5007
Mailing Address - Country:US
Mailing Address - Phone:210-558-8744
Mailing Address - Fax:210-558-4276
Practice Address - Street 1:530 SAN PEDRO AVE
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78212-5007
Practice Address - Country:US
Practice Address - Phone:210-558-8744
Practice Address - Fax:210-558-4276
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-12-17
Last Update Date:2010-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1965873-01Medicaid
TX00Y710Medicare UPIN