Provider Demographics
NPI:1770584187
Name:LA ESPERANZA CLINIC INC
Entity type:Organization
Organization Name:LA ESPERANZA CLINIC INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:
Authorized Official - First Name:ROSIE
Authorized Official - Middle Name:
Authorized Official - Last Name:CASTANEDA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:325-947-5623
Mailing Address - Street 1:1610 S CHADBOURNE ST
Mailing Address - Street 2:
Mailing Address - City:SAN ANGELO
Mailing Address - State:TX
Mailing Address - Zip Code:76903-8510
Mailing Address - Country:US
Mailing Address - Phone:325-658-5339
Mailing Address - Fax:325-659-8534
Practice Address - Street 1:1610 S CHADBOURNE ST
Practice Address - Street 2:
Practice Address - City:SAN ANGELO
Practice Address - State:TX
Practice Address - Zip Code:76903-8510
Practice Address - Country:US
Practice Address - Phone:325-658-5339
Practice Address - Fax:325-659-8534
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-08-09
Last Update Date:2024-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX261QF0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QF0400XAmbulatory Health Care FacilitiesClinic/CenterFederally Qualified Health Center (FQHC)
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX111604802Medicaid
00433TOtherBCBS
451902Medicare Oscar/Certification