Provider Demographics
NPI:1104128990
Name:PRONTOMED CLINIC, PLLC
Entity type:Organization
Organization Name:PRONTOMED CLINIC, PLLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JAIRO
Authorized Official - Middle Name:ANTONIO
Authorized Official - Last Name:PUENTES
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:361-852-0852
Mailing Address - Street 1:3434 SARATOGA BLVD
Mailing Address - Street 2:STE 103
Mailing Address - City:CORPUS CHRISTI
Mailing Address - State:TX
Mailing Address - Zip Code:78415-5822
Mailing Address - Country:US
Mailing Address - Phone:361-852-0852
Mailing Address - Fax:361-852-2280
Practice Address - Street 1:3434 SARATOGA BLVD
Practice Address - Street 2:STE 103
Practice Address - City:CORPUS CHRISTI
Practice Address - State:TX
Practice Address - Zip Code:78415-5822
Practice Address - Country:US
Practice Address - Phone:361-852-0852
Practice Address - Fax:361-852-2280
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-11-30
Last Update Date:2011-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXMDE2071261QU0200X
TXE2071208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationGroup - Multi-Specialty
No261QU0200XAmbulatory Health Care FacilitiesClinic/CenterUrgent CareGroup - Multi-Specialty