| Clinica Latina Divino Nazareno Llc | |
|
4458 S Staples St Corpus Christi TX 78411-2602 | |
| (361) 236-4382 | |
| (281) 298-6655 |
| Full Name | Clinica Latina Divino Nazareno Llc |
|---|---|
| Speciality | Family Medicine |
| Location | 4458 S Staples St, Corpus Christi, Texas |
| Authorized Official Name and Position | Elio Gonzalez Miranda (FNP) |
| Authorized Official Contact | 3612364382 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Clinica Latina Divino Nazareno Llc 4458 S Staples St Corpus Christi TX 78411-2602 Ph: (361) 236-4382 | Clinica Latina Divino Nazareno Llc 4458 S Staples St Corpus Christi TX 78411-2602 Ph: (361) 236-4382 |
| NPI Number | 1710618210 |
|---|---|
| Provider Enumeration Date | 06/23/2022 |
| Last Update Date | 06/23/2022 |
| Medicare PECOS PAC ID | 7012386709 |
|---|---|
| Medicare Enrollment ID | O20221220002386 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1710618210 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | (* (Not Available)) | Primary |
| Provider Name | Elio Gonzalez Miranda |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1568136075 PECOS PAC ID: 7911302690 Enrollment ID: I20221220002831 |
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