Provider Demographics
NPI:1154058337
Name:CLINICA VITAL CARE LLC
Entity type:Organization
Organization Name:CLINICA VITAL CARE LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:MEDICAL PROVIDER
Authorized Official - Prefix:MISS
Authorized Official - First Name:MAYLIN
Authorized Official - Middle Name:
Authorized Official - Last Name:DIAZ LOPEZ
Authorized Official - Suffix:
Authorized Official - Credentials:FNP
Authorized Official - Phone:832-705-8586
Mailing Address - Street 1:12033 VETERANS MEMORIAL DR
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77067-1055
Mailing Address - Country:US
Mailing Address - Phone:832-705-8585
Mailing Address - Fax:832-705-8586
Practice Address - Street 1:12033 VETERANS MEMORIAL DR
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77067-1055
Practice Address - Country:US
Practice Address - Phone:832-705-8585
Practice Address - Fax:832-705-8586
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-08-06
Last Update Date:2024-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Single Specialty