Provider Demographics
NPI:1528242658
Name:FAZ LABASBAS LLC
Entity type:Organization
Organization Name:FAZ LABASBAS LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:BILLING MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:DENISE
Authorized Official - Middle Name:C
Authorized Official - Last Name:GUZMAN
Authorized Official - Suffix:
Authorized Official - Credentials:MOS
Authorized Official - Phone:956-854-4069
Mailing Address - Street 1:505 S ANGELITA ST
Mailing Address - Street 2:SUITE 16
Mailing Address - City:WESLACO
Mailing Address - State:TX
Mailing Address - Zip Code:78596-4356
Mailing Address - Country:US
Mailing Address - Phone:956-854-4069
Mailing Address - Fax:956-973-8972
Practice Address - Street 1:505 S ANGELITA ST
Practice Address - Street 2:SUITE 16
Practice Address - City:WESLACO
Practice Address - State:TX
Practice Address - Zip Code:78596
Practice Address - Country:US
Practice Address - Phone:956-854-4069
Practice Address - Fax:956-973-8972
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-12-26
Last Update Date:2007-12-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0400XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation