Provider Demographics
NPI:1386304871
Name:PADRE HOME AND CLINIC HEALTHCARE, PLLC
Entity type:Organization
Organization Name:PADRE HOME AND CLINIC HEALTHCARE, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MARY
Authorized Official - Middle Name:DOLORES
Authorized Official - Last Name:GARCIA
Authorized Official - Suffix:
Authorized Official - Credentials:APRN-CNP
Authorized Official - Phone:361-533-1023
Mailing Address - Street 1:3210 REID DR STE M
Mailing Address - Street 2:
Mailing Address - City:CORPUS CHRISTI
Mailing Address - State:TX
Mailing Address - Zip Code:78404-2524
Mailing Address - Country:US
Mailing Address - Phone:361-882-1917
Mailing Address - Fax:361-882-7507
Practice Address - Street 1:3210 REID DR STE M
Practice Address - Street 2:
Practice Address - City:CORPUS CHRISTI
Practice Address - State:TX
Practice Address - Zip Code:78404-2524
Practice Address - Country:US
Practice Address - Phone:361-882-1917
Practice Address - Fax:361-882-7507
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-12-23
Last Update Date:2023-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Multi-Specialty
No261QC1500XAmbulatory Health Care FacilitiesClinic/CenterCommunity Health
No363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontologyGroup - Multi-Specialty