Provider Demographics
NPI:1053007807
Name:CLINICA DE GUADALUPE BELTLINE LLC
Entity type:Organization
Organization Name:CLINICA DE GUADALUPE BELTLINE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:CINDY
Authorized Official - Middle Name:
Authorized Official - Last Name:OLALDE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:214-240-1506
Mailing Address - Street 1:14951 DALLAS PKWY STE 190
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75254-6894
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:3583 N BELT LINE RD
Practice Address - Street 2:
Practice Address - City:IRVING
Practice Address - State:TX
Practice Address - Zip Code:75062-7804
Practice Address - Country:US
Practice Address - Phone:469-845-3051
Practice Address - Fax:469-854-3049
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-04-14
Last Update Date:2023-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty