1053488239 NPI number — EL ORO DEL PUEBLO SERVICES, INC.

Table of content: (NPI 1053488239)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1053488239 NPI number — EL ORO DEL PUEBLO SERVICES, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
EL ORO DEL PUEBLO SERVICES, INC.
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:
6
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:
1053488239
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
09/23/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 267
Provider Second Line Business Mailing Address:
916 MIKE CHAPA
Provider Business Mailing Address City Name:
WESLACO
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
78599-0267
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
956-968-1271
Provider Business Mailing Address Fax Number:
968-973-9799

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
916 MIKE CHAPA
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LA VILLA
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
78562
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
956-968-1271
Provider Business Practice Location Address Fax Number:
956-973-9799
Provider Enumeration Date:
11/30/2006

Additional Information

Authorized Official

Authorized Official Last Name:
GONZALEZ
Authorized Official First Name:
BLANCA
Authorized Official Middle Name:
E
Authorized Official Title or Position:
VICE PRESIDENT
Authorized Official Telephone Number:
956-968-1271

Provider Taxonomy Codes

  • Taxonomy code: 261QA0600X , with the licence number:  117281 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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