Provider Demographics
NPI:1174702872
Name:MONTE CRISTO FAMILY CLINIC
Entity type:Organization
Organization Name:MONTE CRISTO FAMILY CLINIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:RIAD
Authorized Official - Middle Name:ALI
Authorized Official - Last Name:ABOUJAMOUS
Authorized Official - Suffix:
Authorized Official - Credentials:NP
Authorized Official - Phone:956-383-8300
Mailing Address - Street 1:3002 N CLOSNER 281 STE B
Mailing Address - Street 2:
Mailing Address - City:EDINBURG
Mailing Address - State:TX
Mailing Address - Zip Code:78541-7162
Mailing Address - Country:US
Mailing Address - Phone:956-383-8300
Mailing Address - Fax:956-383-3006
Practice Address - Street 1:3002 N CLOSNER BLVD STE B
Practice Address - Street 2:
Practice Address - City:EDINBURG
Practice Address - State:TX
Practice Address - Zip Code:78541-7162
Practice Address - Country:US
Practice Address - Phone:956-383-8300
Practice Address - Fax:956-383-3006
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-30
Last Update Date:2007-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX647801363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX0071MYOtherBCBS
TX0071MYOtherBCBS