Provider Demographics
NPI:1306082623
Name:NOLANA FAMILY MEDCLINIC
Entity type:Organization
Organization Name:NOLANA FAMILY MEDCLINIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CO OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:ROLANDO
Authorized Official - Middle Name:
Authorized Official - Last Name:BENITEZ
Authorized Official - Suffix:
Authorized Official - Credentials:PA-C
Authorized Official - Phone:956-358-6975
Mailing Address - Street 1:926 W NOLANA LOOP
Mailing Address - Street 2:STE B
Mailing Address - City:PHARR
Mailing Address - State:TX
Mailing Address - Zip Code:78577-7957
Mailing Address - Country:US
Mailing Address - Phone:956-358-6975
Mailing Address - Fax:956-519-8456
Practice Address - Street 1:926 W NOLANA LOOP
Practice Address - Street 2:STE B
Practice Address - City:PHARR
Practice Address - State:TX
Practice Address - Zip Code:78577-7957
Practice Address - Country:US
Practice Address - Phone:956-358-6975
Practice Address - Fax:956-519-8456
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-12-17
Last Update Date:2008-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty