Las Fuentes Medical Clinic | |
1400 W Griffin Park Suite 1 Mission TX 78572-0001 | |
(956) 997-0106 | |
(956) 997-0105 |
Full Name | Las Fuentes Medical Clinic |
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Speciality | Family Medicine |
Location | 1400 W Griffin Park, Mission, Texas |
Authorized Official Name and Position | Roberto Mauro Lopez (PRESIDENT) |
Authorized Official Contact | 9569970106 |
Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
Mailing Address | Practice Location Address |
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Las Fuentes Medical Clinic 1400 W Griffin Park Suite 1 Mission TX 78572-0001 Ph: (956) 997-0106 | Las Fuentes Medical Clinic 1400 W Griffin Park Suite 1 Mission TX 78572-0001 Ph: (956) 997-0106 |
NPI Number | 1619548104 |
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Provider Enumeration Date | 07/06/2021 |
Last Update Date | 12/09/2021 |
Medicare PECOS PAC ID | 5193128205 |
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Medicare Enrollment ID | O20210727003964 |
Identifier | Type | State | Issuer |
---|---|---|---|
1619548104 | NPI | - | NPPES |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
207Q00000X | Family Medicine | (* (Not Available)) | Primary |
Provider Name | Roberto Mauro Lopez |
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Provider Type | Practitioner - Family Practice |
Provider Identifiers | NPI Number: 1740662840 PECOS PAC ID: 2668728007 Enrollment ID: I20180627002439 |
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