Provider Demographics
NPI:1578206496
Name:CLINICA FAMILIAR LA BUENA FE LLC
Entity type:Organization
Organization Name:CLINICA FAMILIAR LA BUENA FE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:FNP
Authorized Official - Prefix:
Authorized Official - First Name:MADELIN
Authorized Official - Middle Name:
Authorized Official - Last Name:PEREZ ANTELA
Authorized Official - Suffix:
Authorized Official - Credentials:APRN-CNP
Authorized Official - Phone:469-586-4574
Mailing Address - Street 1:2000 ESTERS RD STE 120
Mailing Address - Street 2:
Mailing Address - City:IRVING
Mailing Address - State:TX
Mailing Address - Zip Code:75061-8020
Mailing Address - Country:US
Mailing Address - Phone:469-586-4574
Mailing Address - Fax:469-524-3248
Practice Address - Street 1:2000 ESTERS RD STE 120
Practice Address - Street 2:
Practice Address - City:IRVING
Practice Address - State:TX
Practice Address - Zip Code:75061-8020
Practice Address - Country:US
Practice Address - Phone:469-586-4574
Practice Address - Fax:469-524-3248
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-04-18
Last Update Date:2022-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Single Specialty