| NPI | 1740997220 |
|---|---|
| Doing Business As | CLINICA HISPANA VIDA SANA |
| Entity Type | Organization |
| Authorized Contact | RAFAEL LUIS FONSECA Family Nurse Practitioner 972-904-0812 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QP2300X Clinic/Center, Primary Care |
| Enumeration Date | 2022-11-03 |
| Last Update Date | 2022-11-03 |