Clinica Guadalupe Grand Plaza,llc
Family Medicine in Fort Worth, TX. Organization (NPI-2).
NPI number1316633043
StatusActive
Last updated in NPPESApr 14, 2023
Details
- NPI
- 1316633043
- Entity type
- Organization (NPI-2)
- Legal business name
- Clinica Guadalupe Grand Plaza,llc
- Organization subpart
- No
- Enumeration date
- Apr 14, 2023
- Certification date
- Apr 14, 2023
- Last updated
- Apr 14, 2023
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 207Q00000X | Family Medicine | – | – | Yes |
Practice location
4200 South Fwy Ste 15Fort Worth, TX 76115-1423
Phone 469-931-2538
Mailing address
14951 Dallas Pkwy Ste 190Dallas, TX 75254-6894
Authorized official
Cindy Olalde
Officer
2142401506
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