1891803078 NPI number — THERESA L.VALLADARES, M.D.P.A.

Table of content: (NPI 1891803078)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1891803078 NPI number — THERESA L.VALLADARES, M.D.P.A.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
THERESA L.VALLADARES, M.D.P.A.
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1891803078
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/10/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2302 RED RIVER DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MISSION
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
78572-7454
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
956-702-0024
Provider Business Mailing Address Fax Number:
956-702-0616

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
923 E FERGUSON ST
Provider Second Line Business Practice Location Address:
SUITE C
Provider Business Practice Location Address City Name:
PHARR
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
78577-2613
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
956-702-0024
Provider Business Practice Location Address Fax Number:
956-702-0616
Provider Enumeration Date:
08/28/2006

Additional Information

Authorized Official

Authorized Official Last Name:
VALLADARES
Authorized Official First Name:
THERESA
Authorized Official Middle Name:
LYNN
Authorized Official Title or Position:
MEDICAL DOCTOR / PHYSICIAN OWNER
Authorized Official Telephone Number:
956-702-0024

Provider Taxonomy Codes

  • Taxonomy code: 207Q00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 0084PU . This is a "BCBS GROUP #" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 148012102 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".
  • Identifier: 0011MP . This is a "BCBS PROVIDER #" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 173167101 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".
  • Identifier: 173167102 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".




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