Provider Demographics
NPI:1730921545
Name:CLINICA HISPANA LANCASTER LLC
Entity type:Organization
Organization Name:CLINICA HISPANA LANCASTER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL PROVIDER
Authorized Official - Prefix:
Authorized Official - First Name:ROSELIO
Authorized Official - Middle Name:
Authorized Official - Last Name:PEREZ GARCIA
Authorized Official - Suffix:
Authorized Official - Credentials:FNP
Authorized Official - Phone:786-326-1762
Mailing Address - Street 1:3250 W PLEASANT RUN RD STE 160
Mailing Address - Street 2:
Mailing Address - City:LANCASTER
Mailing Address - State:TX
Mailing Address - Zip Code:75146-1071
Mailing Address - Country:US
Mailing Address - Phone:469-747-3005
Mailing Address - Fax:
Practice Address - Street 1:3250 W PLEASANT RUN RD STE 160
Practice Address - Street 2:
Practice Address - City:LANCASTER
Practice Address - State:TX
Practice Address - Zip Code:75146-1071
Practice Address - Country:US
Practice Address - Phone:469-747-3005
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-06-11
Last Update Date:2024-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGroup - Single Specialty