Provider Demographics
NPI:1538613500
Name:ALEGRIA FAMILY CLINIC PLLC
Entity type:Organization
Organization Name:ALEGRIA FAMILY CLINIC PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:NP, OWNER
Authorized Official - Prefix:
Authorized Official - First Name:LEENA
Authorized Official - Middle Name:
Authorized Official - Last Name:PANICKER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:469-289-7755
Mailing Address - Street 1:2241 PEGGY LN
Mailing Address - Street 2:SUITE B
Mailing Address - City:GARLAND
Mailing Address - State:TX
Mailing Address - Zip Code:75042-5732
Mailing Address - Country:US
Mailing Address - Phone:972-205-1047
Mailing Address - Fax:972-205-1049
Practice Address - Street 1:2241 PEGGY LN
Practice Address - Street 2:SUITE B
Practice Address - City:GARLAND
Practice Address - State:TX
Practice Address - Zip Code:75042-5732
Practice Address - Country:US
Practice Address - Phone:972-205-1047
Practice Address - Fax:972-205-1049
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-08-08
Last Update Date:2016-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Multi-Specialty