Provider Demographics
NPI:1588972657
Name:NUESTRA SALUD HEALTH CLINIC,P.C.
Entity type:Organization
Organization Name:NUESTRA SALUD HEALTH CLINIC,P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:COMPANY ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:
Authorized Official - Last Name:MORAN
Authorized Official - Suffix:
Authorized Official - Credentials:JD,FNP-BC
Authorized Official - Phone:956-568-5013
Mailing Address - Street 1:101 W HILLSIDE RD
Mailing Address - Street 2:SUITE 1
Mailing Address - City:LAREDO
Mailing Address - State:TX
Mailing Address - Zip Code:78041-3141
Mailing Address - Country:US
Mailing Address - Phone:956-718-2134
Mailing Address - Fax:
Practice Address - Street 1:1501 E BUSTAMANTE ST
Practice Address - Street 2:SUITE D
Practice Address - City:LAREDO
Practice Address - State:TX
Practice Address - Zip Code:78041-8905
Practice Address - Country:US
Practice Address - Phone:956-568-5013
Practice Address - Fax:956-795-4753
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-09-22
Last Update Date:2011-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX630856261QU0200X
363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Single Specialty
No261QU0200XAmbulatory Health Care FacilitiesClinic/CenterUrgent Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX217291801Medicaid