Organization
FUENTE DE JUVENTUD, INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
SONIA GALLEGOS MPH (ADMINISTRATOR)
(956) 702-3323
Entity
Organization
Contact information
Practice address
2008 REDSKIN AVE STE A, DONNA, TX 78537-3299
(956) 377-5158
(956) 377-5204
Mailing address
1138 E INTERSTATE 2 STE E, PHARR, TX 78577-6519
(956) 702-3323
(956) 782-5448
Taxonomy
Speciality
Code
Description
License number
State
261QA0600X
Adult Day Care Clinic/Center
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
8007326201
—
TX
Enumeration date
05/14/2022
Last updated
05/14/2022
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