Provider Demographics
NPI:1316604580
Name:TX PRIVATE PRACTICE LLC
Entity type:Organization
Organization Name:TX PRIVATE PRACTICE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINIC ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:JULIE
Authorized Official - Middle Name:
Authorized Official - Last Name:GAZA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:210-862-8849
Mailing Address - Street 1:2209 N PADRE ISLAND DR STE K1
Mailing Address - Street 2:
Mailing Address - City:CORPUS CHRISTI
Mailing Address - State:TX
Mailing Address - Zip Code:78408-2261
Mailing Address - Country:US
Mailing Address - Phone:210-862-8849
Mailing Address - Fax:361-666-1019
Practice Address - Street 1:2209 N PADRE ISLAND DR STE K1
Practice Address - Street 2:
Practice Address - City:CORPUS CHRISTI
Practice Address - State:TX
Practice Address - Zip Code:78408-2261
Practice Address - Country:US
Practice Address - Phone:361-500-4200
Practice Address - Fax:361-666-1019
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-11-23
Last Update Date:2021-11-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty