# MDOC HEALTH SERVICES,LLC

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- **Entity:** Organization
- **Status:** Active
- **Other names:** CLINICA HISPANA ABILENE
- **Organization subpart:** No

## Provider details

- **NPI number:** 1285377507
- **Authorized official:** ALIESKI MASTRAPA DOMINGUEZ (MEMBER)
- **Authorized official phone:** (281) 381-6190

## Contact information

- **Practice address:** 4371 S 1ST ST, ABILENE, TX 79605-1469
- **Practice address phone:** (325) 701-4082
- **Practice address fax:** (325) 701-4081
- **Mailing address:** PO BOX 2799, PORTER, TX 77365-2799
- **Mailing address phone:** (281) 381-6190
- **Mailing address fax:** (281) 747-7162

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 208D00000X | General Practice Physician | — | NULL | Yes |
| 208D00000X | General Practice Physician | — | — | Yes |
| 363L00000X | Nurse Practitioner | — | NULL | — |
| 363L00000X | Nurse Practitioner | — | — | — |

## Other

- **Enumeration date:** 04/14/2022
- **Last updated:** 04/15/2022