Organization
MAGNOLIA PRIMARY CARE LLC
Active
Other names
Magnolia Primary Care LLC
Organization subpart
No
Provider details
NPI number
Authorized official
CLAUDIA CARRILLO (MEMBER)
(956) 235-2973
Entity
Organization
Contact information
Practice address
2101 S EJIDO AVE, LAREDO, TX 78046-6750
(956) 235-2973
Mailing address
2101 S EJIDO AVE, LAREDO, TX 78046-6750
(956) 235-2973
Taxonomy
Speciality
Code
Description
License number
State
251C00000X
Developmentally Disabled Services Day Training Agency
—
—
253Z00000X
In Home Supportive Care Agency
—
—
373H00000X
Day Training/Habilitation Specialist
—
—
3747P1801X
Personal Care Attendant
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
804361405
—
TX
Enumeration date
01/06/2022
Last updated
01/06/2022
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