Basic Information
Provider Information | |||||||||
NPI: | 1003977943 | ||||||||
EntityType: | 2 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: | COMMUNITY ACTION COUNCIL OF SOUTH TEXAS | ||||||||
LastName: |   | ||||||||
FirstName: |   | ||||||||
MiddleName: |   | ||||||||
NamePrefix: |   | ||||||||
NameSuffix: |   | ||||||||
Credential: |   | ||||||||
OtherOrganizationName: | ROMA HEALTH CLINIC | ||||||||
OtherOrganizationType: | 3 | ||||||||
OtherLastName: |   | ||||||||
OtherFirstName: |   | ||||||||
OtherMiddleName: |   | ||||||||
OtherNamePrefix: |   | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: |   | ||||||||
OtherLastNameType: |   | ||||||||
Mailing Information | |||||||||
Address1: | PO BOX 98 | ||||||||
Address2: |   | ||||||||
City: | RIO GRANDE CITY | ||||||||
State: | TX | ||||||||
PostalCode: | 785820098 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 9564872585 | ||||||||
FaxNumber: | 9564876670 | ||||||||
Practice Location | |||||||||
Address1: | 683 N CANALES CIR | ||||||||
Address2: |   | ||||||||
City: | ROMA | ||||||||
State: | TX | ||||||||
PostalCode: | 785848053 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 9568472312 | ||||||||
FaxNumber: | 9568490143 | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 12/13/2006 | ||||||||
LastUpdateDate: | 08/22/2020 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: |   | ||||||||
AuthorizedOfficialLastName: | ZARATE | ||||||||
AuthorizedOfficialFirstName: | FRANCISCO | ||||||||
AuthorizedOfficialMiddleName: | G | ||||||||
AuthorizedOfficialTitleorPosition: | EXEXUTIVE DIRECTOR | ||||||||
AuthorizedOfficialTelephone: | 9564872585 | ||||||||
IsSoleProprietor: |   | ||||||||
IsOrganizationSubpart: | N | ||||||||
ParentOrganizationLBN: |   | ||||||||
AuthorizedOfficialNamePrefix: | MR. | ||||||||
AuthorizedOfficialNameSuffix: |   | ||||||||
AuthorizedOfficialCredential: |   | ||||||||
NPICertificationDate: |   |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 173000000X |   |   | Y | 193200000X MULTI-SPECIALTY GROUP | Other Service Providers | Legal Medicine |   |
No ID Information.