Provider Demographics
NPI:1154102952
Name:PROMEXSA INDUSTRIES, LLC
Entity type:Organization
Organization Name:PROMEXSA INDUSTRIES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:GERARDO
Authorized Official - Middle Name:
Authorized Official - Last Name:NAVARRETE
Authorized Official - Suffix:JR
Authorized Official - Credentials:
Authorized Official - Phone:682-888-6447
Mailing Address - Street 1:415 E BOLT ST STE 433
Mailing Address - Street 2:
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76110-6371
Mailing Address - Country:US
Mailing Address - Phone:682-888-6447
Mailing Address - Fax:817-386-9060
Practice Address - Street 1:415 E BOLT ST STE 433
Practice Address - Street 2:
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76110-6371
Practice Address - Country:US
Practice Address - Phone:682-888-6447
Practice Address - Fax:817-386-9060
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-10-09
Last Update Date:2023-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy