LA FUENTE, INC.
Ambulatory Health at Expressway 83, Sullivan City, TX

License number
Texas 007540
Category
Ambulatory Health
Type
Primary Care
Owner
Name: MR. NOEL A ZAMORA
Title: PRESIDENT
Phone: (956) 485-2400
Address
Address
1723 Expressway 83 W, Sullivan City, TX 78595
National Provider ID: 1871704718
LicenseFiles verified this license of Nov 7, 2017 at the National Plan and Provider Enumeration System.

Organization information

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LA FUENTE INCORPORATED

Sullivan City, TX

Industry:
Individual/Family Services
Doing business as:
La Fuente Inc
Registration:
May 22, 1997
Addresses:
PO Box 280, Sullivan City, TX 78595 (Mailing)
801 W Expwy 83, Sullivan City, TX 78595
State ID:
0144652400
Administration, Owners:
Noel A Zamora (Secretary, President), PO Box 280, Sullivan City, TX 78595,Cecilia Y. Chapa (Administration, Owner)
Agent:
Noel Zamora,Ln Fuente Adult Care 15 Miles West Hwy 83, Mission, TX 78572 (Physical)
TIN:
30119814165

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