Provider Demographics
NPI:1154715977
Name:CLINICA BETESDA CORPORATION
Entity type:Organization
Organization Name:CLINICA BETESDA CORPORATION
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MRS
Authorized Official - First Name:MARIA
Authorized Official - Middle Name:ELENA
Authorized Official - Last Name:GUTIERREZ
Authorized Official - Suffix:
Authorized Official - Credentials:MSN
Authorized Official - Phone:512-587-0732
Mailing Address - Street 1:1100 GRAND AVENUE PKWY
Mailing Address - Street 2:
Mailing Address - City:PFLUGERVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:78660-2194
Mailing Address - Country:US
Mailing Address - Phone:512-579-7249
Mailing Address - Fax:512-551-0047
Practice Address - Street 1:1100 GRAND AVENUE PKWY
Practice Address - Street 2:
Practice Address - City:PFLUGERVILLE
Practice Address - State:TX
Practice Address - Zip Code:78660-2194
Practice Address - Country:US
Practice Address - Phone:512-579-7249
Practice Address - Fax:512-551-0047
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-03-19
Last Update Date:2015-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center