Organization
CLINICA FAMILIAR SAN JOSE, PA
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. JUDY L KUTUGATA RN (BUSINESS MANAGER)
(956) 969-2904
Entity
Organization
Contact information
Practice address
8030 N FM 1015 STE B, MERCEDES, TX 78570-4809
(956) 825-9757
(956) 825-9125
Mailing address
8030 FM 1015 STE B, MERCEDES, TX 78570-4809
(956) 825-9757
(956) 825-9125
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
TA03917
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
117223100
VALLEY HEALTH PLANS
TX
05
—
176879801
—
TX
05
—
176879802
—
TX
01
—
8U4260
BC/BS OF TEXAS
TX
Enumeration date
10/18/2006
Last updated
07/17/2013
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