Individual provider · NPI-1
Benjamin Fombon
Community Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities · Mcallen, TX
NPI number1801231600
StatusActive
Last updated in NPPESMay 7, 2013
Details
- NPI
- 1801231600
- Entity type
- Individual (NPI-1)
- Name
- Benjamin Fombon
- Sex
- Male
- Sole proprietor
- Yes
- Enumeration date
- May 7, 2013
- Last updated
- May 7, 2013
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 320900000X | Community Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities | – | – | Yes |
Practice location
418 E La Vista AveApt A
Mcallen, TX 78501-9562
Phone 956-627-6070
Mailing address
418 E La Vista AveApt A
Mcallen, TX 78501-9562
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