Provider Demographics
NPI:1285449660
Name:CLINICA FAMILIAR LAS AMERICAS FW INC
Entity type:Organization
Organization Name:CLINICA FAMILIAR LAS AMERICAS FW INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:IBONNE
Authorized Official - Middle Name:
Authorized Official - Last Name:LOPEZ MASO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:682-707-5982
Mailing Address - Street 1:1701 NW 25TH ST
Mailing Address - Street 2:
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76164-6850
Mailing Address - Country:US
Mailing Address - Phone:682-707-5982
Mailing Address - Fax:682-707-5984
Practice Address - Street 1:1701 NW 25TH ST
Practice Address - Street 2:
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76164-6850
Practice Address - Country:US
Practice Address - Phone:682-707-5982
Practice Address - Fax:682-707-5984
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-02-11
Last Update Date:2025-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Multi-Specialty