Provider Demographics
NPI:1851592505
Name:HISTORIA DE COLORES
Entity type:Organization
Organization Name:HISTORIA DE COLORES
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:CLEMENTE
Authorized Official - Middle Name:
Authorized Official - Last Name:GUTIERREZ
Authorized Official - Suffix:
Authorized Official - Credentials:ASSOCIATES
Authorized Official - Phone:956-381-1155
Mailing Address - Street 1:205 E MCINTYRE ST
Mailing Address - Street 2:
Mailing Address - City:EDINBURG
Mailing Address - State:TX
Mailing Address - Zip Code:78541-3539
Mailing Address - Country:US
Mailing Address - Phone:956-381-1155
Mailing Address - Fax:956-381-9914
Practice Address - Street 1:205 E MCINTYRE ST
Practice Address - Street 2:
Practice Address - City:EDINBURG
Practice Address - State:TX
Practice Address - Zip Code:78541-3539
Practice Address - Country:US
Practice Address - Phone:956-381-1155
Practice Address - Fax:956-381-9914
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-30
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX003048261QA0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA0600XAmbulatory Health Care FacilitiesClinic/CenterAdult Day Care