Provider Demographics
NPI:1053524199
Name:URIBE, GRACIA
Entity type:Individual
Prefix:
First Name:GRACIA
Middle Name:
Last Name:URIBE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:530 S TEXAS BLVD
Mailing Address - Street 2:SUITE F
Mailing Address - City:WESLACO
Mailing Address - State:TX
Mailing Address - Zip Code:78596-6263
Mailing Address - Country:US
Mailing Address - Phone:956-969-9177
Mailing Address - Fax:956-973-2549
Practice Address - Street 1:530 S TEXAS BLVD
Practice Address - Street 2:SUITE F
Practice Address - City:WESLACO
Practice Address - State:TX
Practice Address - Zip Code:78596-6263
Practice Address - Country:US
Practice Address - Phone:956-969-9177
Practice Address - Fax:956-973-2549
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171W00000XOther Service ProvidersContractor