Provider Demographics
NPI:1902978620
Name:JUAN LLOMPART M.D., P.A.
Entity Type:Organization
Organization Name:JUAN LLOMPART M.D., P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JUAN
Authorized Official - Middle Name:A
Authorized Official - Last Name:LLOMPART-ZENO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:361-572-5105
Mailing Address - Street 1:2705 HOSPITAL DR STE 202
Mailing Address - Street 2:
Mailing Address - City:VICTORIA
Mailing Address - State:TX
Mailing Address - Zip Code:77901-5743
Mailing Address - Country:US
Mailing Address - Phone:361-572-5105
Mailing Address - Fax:361-582-1128
Practice Address - Street 1:2705 HOSPITAL DR STE 202
Practice Address - Street 2:
Practice Address - City:VICTORIA
Practice Address - State:TX
Practice Address - Zip Code:77901-5743
Practice Address - Country:US
Practice Address - Phone:361-572-5105
Practice Address - Fax:361-582-1128
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-15
Last Update Date:2011-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXF9742174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX145297101Medicaid
7603235OtherAETNA
C78269Medicare UPIN
TX00535RMedicare ID - Type Unspecified