Provider Demographics
NPI:1144360348
Name:ALAMO FIESTA MEDICAL SUPPLY
Entity type:Organization
Organization Name:ALAMO FIESTA MEDICAL SUPPLY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JULIETA
Authorized Official - Middle Name:
Authorized Official - Last Name:QUIRINO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:956-702-2167
Mailing Address - Street 1:BOX 3716
Mailing Address - Street 2:
Mailing Address - City:ALAMO
Mailing Address - State:TX
Mailing Address - Zip Code:78516
Mailing Address - Country:US
Mailing Address - Phone:956-702-1848
Mailing Address - Fax:956-702-1852
Practice Address - Street 1:1040 WEST ELLIS
Practice Address - Street 2:
Practice Address - City:ALAMO
Practice Address - State:TX
Practice Address - Zip Code:78516-2593
Practice Address - Country:US
Practice Address - Phone:956-702-1848
Practice Address - Fax:956-702-1852
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-07
Last Update Date:2011-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX0076352332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX172063302Medicaid
TX172063301Medicaid
TX172063301Medicaid