Provider Demographics
NPI:1679997738
Name:CIMARRON FAMILY PRACTICE AND NEURO MEDICAL CLINIC, PLLC
Entity type:Organization
Organization Name:CIMARRON FAMILY PRACTICE AND NEURO MEDICAL CLINIC, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:JUAN
Authorized Official - Middle Name:J
Authorized Official - Last Name:MARTINEZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:956-739-7705
Mailing Address - Street 1:901 TRAVIS ST
Mailing Address - Street 2:SUITE 1
Mailing Address - City:MISSION
Mailing Address - State:TX
Mailing Address - Zip Code:78572-2514
Mailing Address - Country:US
Mailing Address - Phone:956-739-7705
Mailing Address - Fax:
Practice Address - Street 1:901 TRAVIS ST
Practice Address - Street 2:SUITE 1
Practice Address - City:MISSION
Practice Address - State:TX
Practice Address - Zip Code:78572-2514
Practice Address - Country:US
Practice Address - Phone:956-739-7705
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-02-10
Last Update Date:2014-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXE3723207T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207T00000XAllopathic & Osteopathic PhysiciansNeurological SurgeryGroup - Multi-Specialty