Provider Demographics
NPI:1528799251
Name:SPENCE FAMILY PRIMARY CARE CLINIC
Entity type:Organization
Organization Name:SPENCE FAMILY PRIMARY CARE CLINIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:MARIO
Authorized Official - Middle Name:
Authorized Official - Last Name:AGUILAR
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:917-733-2815
Mailing Address - Street 1:336 S 8TH ST
Mailing Address - Street 2:
Mailing Address - City:RAYMONDVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:78580-2526
Mailing Address - Country:US
Mailing Address - Phone:956-689-2456
Mailing Address - Fax:
Practice Address - Street 1:336 S 8TH ST
Practice Address - Street 2:
Practice Address - City:RAYMONDVILLE
Practice Address - State:TX
Practice Address - Zip Code:78580-2526
Practice Address - Country:US
Practice Address - Phone:956-689-2456
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-06-22
Last Update Date:2022-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty