Provider Demographics
NPI:1972335347
Name:NUEVO LEON FAMILY CLINIC PLLC
Entity type:Organization
Organization Name:NUEVO LEON FAMILY CLINIC PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:BRENDA
Authorized Official - Middle Name:
Authorized Official - Last Name:MEDINA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:469-518-9677
Mailing Address - Street 1:2379 GUS THOMASSON RD STE 100
Mailing Address - Street 2:
Mailing Address - City:MESQUITE
Mailing Address - State:TX
Mailing Address - Zip Code:75150-7102
Mailing Address - Country:US
Mailing Address - Phone:469-518-9677
Mailing Address - Fax:469-518-9655
Practice Address - Street 1:2379 GUS THOMASSON RD STE 100
Practice Address - Street 2:
Practice Address - City:MESQUITE
Practice Address - State:TX
Practice Address - Zip Code:75150-7102
Practice Address - Country:US
Practice Address - Phone:469-518-9677
Practice Address - Fax:469-518-9655
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-08-15
Last Update Date:2024-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Multi-Specialty