Provider Demographics
NPI:1528642402
Name:CONSULTORIO GENERAL HISPANO
Entity type:Organization
Organization Name:CONSULTORIO GENERAL HISPANO
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PROVIDER
Authorized Official - Prefix:
Authorized Official - First Name:ANTONIO
Authorized Official - Middle Name:
Authorized Official - Last Name:BRIZUELA
Authorized Official - Suffix:
Authorized Official - Credentials:NP
Authorized Official - Phone:214-497-7346
Mailing Address - Street 1:2502 S BELT LINE RD STE 400
Mailing Address - Street 2:
Mailing Address - City:GRAND PRAIRIE
Mailing Address - State:TX
Mailing Address - Zip Code:75052-5398
Mailing Address - Country:US
Mailing Address - Phone:214-347-3619
Mailing Address - Fax:
Practice Address - Street 1:2502 S BELT LINE RD STE 400
Practice Address - Street 2:
Practice Address - City:GRAND PRAIRIE
Practice Address - State:TX
Practice Address - Zip Code:75052-5398
Practice Address - Country:US
Practice Address - Phone:214-347-3619
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-05-07
Last Update Date:2025-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Multi-Specialty