Organization
MCJV
Active
Other names
Zona Azul
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. EILEEN ISAACS (PRACTICE MANAGER)
(361) 779-6093
Entity
Organization
Contact information
Practice address
614 ELM ST, PORTLAND, TX 78374-1714
(361) 563-2966
Mailing address
614 ELM ST, PORTLAND, TX 78374-1714
Taxonomy
Speciality
Code
Description
License number
State
261Q00000X
Clinic/Center
Primary
—
—
Other
Enumeration date
09/01/2023
Last updated
09/01/2023
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