Provider Demographics
NPI:1134149040
Name:LA BLANCA FAMILY CLINIC, INC
Entity type:Organization
Organization Name:LA BLANCA FAMILY CLINIC, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:ISABEL
Authorized Official - Middle Name:
Authorized Official - Last Name:GUZMAN
Authorized Official - Suffix:
Authorized Official - Credentials:ANP
Authorized Official - Phone:956-262-9823
Mailing Address - Street 1:PO BOX 686
Mailing Address - Street 2:
Mailing Address - City:LA BLANCA
Mailing Address - State:TX
Mailing Address - Zip Code:78558-0686
Mailing Address - Country:US
Mailing Address - Phone:956-262-9823
Mailing Address - Fax:956-262-9622
Practice Address - Street 1:18360 FM 493
Practice Address - Street 2:SUITE 1
Practice Address - City:EDINBURG
Practice Address - State:TX
Practice Address - Zip Code:78542-1869
Practice Address - Country:US
Practice Address - Phone:956-262-9823
Practice Address - Fax:956-262-9622
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-20
Last Update Date:2010-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXJ6969174400000X
TX580338363LP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary CareGroup - Multi-Specialty
No174400000XOther Service ProvidersSpecialistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX164816401Medicaid
TX00243UMedicare PIN
TX00243UMedicare ID - Type UnspecifiedMEDICARE PROVIDER NUMBER