Provider Demographics
NPI:1679876890
Name:LA ESTRELLA-LAKESIDE LLC
Entity type:Organization
Organization Name:LA ESTRELLA-LAKESIDE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:REGISTERED AGENT
Authorized Official - Prefix:MR
Authorized Official - First Name:CHARLES
Authorized Official - Middle Name:S
Authorized Official - Last Name:RAMON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:210-432-5050
Mailing Address - Street 1:2301 SAN FERNANDO ST
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78207-5229
Mailing Address - Country:US
Mailing Address - Phone:210-432-5050
Mailing Address - Fax:210-432-5050
Practice Address - Street 1:1000 CINCINNATI AVE
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78201-6030
Practice Address - Country:US
Practice Address - Phone:210-432-5050
Practice Address - Fax:210-432-5050
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-12-09
Last Update Date:2010-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX261QA0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA0600XAmbulatory Health Care FacilitiesClinic/CenterAdult Day Care