| NPI | 1740997220 |
|---|---|
| Doing Business As | CLINICA HISPANA VIDA SANA |
| Entity Type | Organization |
| Authorized Contact | RAFAEL LUIS FONSECA Family Nurse Practitioner 469-277-8858 |
| Organization Subpart ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner |
| Enumeration Date | 2022-11-03 |
| Last Update Date | 2024-09-09 |