Organization
AMISTAD SURGICAL & LAPAROSCOPIC CLINIC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. JOSE ANTONIO MAEDA M.D. (DIRECTOR)
(830) 774-4099
Entity
Organization
Contact information
Practice address
517 N BEDELL AVE, DEL RIO, TX 78840-4807
(830) 774-4099
(830) 774-0890
Mailing address
517 N BEDELL AVE, DEL RIO, TX 78840-4807
(830) 774-4099
(830) 774-0890
Taxonomy
Speciality
Code
Description
License number
State
261QC1800X
Corporate Health Clinic/Center
Primary
J1719
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0062NP
BCBSTX
TX
Enumeration date
01/08/2008
Last updated
01/08/2008
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