| Clinicalatinasanrafael Llc | |
|
1620 S Padre Island Dr Ste 180 Corpus Christi TX 78416-1361 | |
| (361) 221-1905 | |
| (361) 201-5540 |
| Full Name | Clinicalatinasanrafael Llc |
|---|---|
| Speciality | Family Medicine |
| Location | 1620 S Padre Island Dr Ste 180, Corpus Christi, Texas |
| Authorized Official Name and Position | Angela Leon Granado (FNP) |
| Authorized Official Contact | 3612211905 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Clinicalatinasanrafael Llc 1620 S Padre Island Dr Ste 180 Corpus Christi TX 78416-1361 Ph: (361) 221-1905 | Clinicalatinasanrafael Llc 1620 S Padre Island Dr Ste 180 Corpus Christi TX 78416-1361 Ph: (361) 221-1905 |
| NPI Number | 1548991037 |
|---|---|
| Provider Enumeration Date | 06/23/2022 |
| Last Update Date | 07/15/2022 |
| Medicare PECOS PAC ID | 1355725342 |
|---|---|
| Medicare Enrollment ID | O20220824002746 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1548991037 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | (* (Not Available)) | Primary |
| Provider Name | Angela Leon Granado |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1932873445 PECOS PAC ID: 7113323056 Enrollment ID: I20220824002332 |
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