Provider Demographics
NPI:1285999680
Name:LITTLE WAYS HEALTH CLINIC, LLC
Entity type:Organization
Organization Name:LITTLE WAYS HEALTH CLINIC, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:FAMILY NURSE PRACTITIONER
Authorized Official - Prefix:
Authorized Official - First Name:MARTA
Authorized Official - Middle Name:
Authorized Official - Last Name:PEREZ
Authorized Official - Suffix:
Authorized Official - Credentials:MSN, FNP-BC
Authorized Official - Phone:956-627-1197
Mailing Address - Street 1:2621 W TRENTON RD
Mailing Address - Street 2:
Mailing Address - City:EDINBURG
Mailing Address - State:TX
Mailing Address - Zip Code:78539-3432
Mailing Address - Country:US
Mailing Address - Phone:956-627-1197
Mailing Address - Fax:956-672-2071
Practice Address - Street 1:2621 W TRENTON RD
Practice Address - Street 2:
Practice Address - City:EDINBURG
Practice Address - State:TX
Practice Address - Zip Code:78539-3432
Practice Address - Country:US
Practice Address - Phone:956-627-1197
Practice Address - Fax:956-672-2071
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:LITTLE WAYS HEALH CLINIC LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2012-07-11
Last Update Date:2014-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX712010363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Multi-Specialty