| Clinica Familiar San Jose, Pa | |
|
8030 N Fm 1015 Ste B Mercedes TX 78570-4809 | |
| (956) 825-9757 | |
| (956) 825-9125 |
| Full Name | Clinica Familiar San Jose, Pa |
|---|---|
| Speciality | Family Medicine |
| Location | 8030 N Fm 1015 Ste B, Mercedes, Texas |
| Authorized Official Name and Position | Judy L Kutugata (BUSINESS MANAGER) |
| Authorized Official Contact | 9569692904 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Clinica Familiar San Jose, Pa 8030 Fm 1015 Ste B Mercedes TX 78570-4809 Ph: (956) 825-9757 | Clinica Familiar San Jose, Pa 8030 N Fm 1015 Ste B Mercedes TX 78570-4809 Ph: (956) 825-9757 |
| NPI Number | 1174604763 |
|---|---|
| Provider Enumeration Date | 10/18/2006 |
| Last Update Date | 07/17/2013 |
| Medicare PECOS PAC ID | 6800827478 |
|---|---|
| Medicare Enrollment ID | O20051104000231 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1174604763 | NPI | - | NPPES |
| 117223100 | Other | TX | VALLEY HEALTH PLANS |
| 8U4260 | Other | TX | BC/BS OF TEXAS |
| 176879802 | Medicaid | TX | |
| 176879801 | Medicaid | TX |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | TA03917 (Texas) | Primary |
| Provider Name | Jorge L Kutugata |
|---|---|
| Provider Type | Practitioner - Pediatric Medicine |
| Provider Identifiers | NPI Number: 1285748996 PECOS PAC ID: 1355372921 Enrollment ID: I20050823000824 |
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