Provider Demographics
NPI:1962063917
Name:LA FAMILIA HEALTH CLINIC PLLC
Entity type:Organization
Organization Name:LA FAMILIA HEALTH CLINIC PLLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:NURSE PRACTITIONER/ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:ROSA
Authorized Official - Middle Name:A
Authorized Official - Last Name:RENDON
Authorized Official - Suffix:
Authorized Official - Credentials:APRN
Authorized Official - Phone:956-635-1170
Mailing Address - Street 1:1105 CORPUS CHRISTI ST
Mailing Address - Street 2:
Mailing Address - City:LAREDO
Mailing Address - State:TX
Mailing Address - Zip Code:78040-5258
Mailing Address - Country:US
Mailing Address - Phone:956-635-1170
Mailing Address - Fax:
Practice Address - Street 1:1105 CORPUS CHRISTI ST
Practice Address - Street 2:
Practice Address - City:LAREDO
Practice Address - State:TX
Practice Address - Zip Code:78040-5258
Practice Address - Country:US
Practice Address - Phone:956-635-1170
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-06-20
Last Update Date:2019-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Single Specialty
No261QU0200XAmbulatory Health Care FacilitiesClinic/CenterUrgent CareGroup - Single Specialty