1215350954 NPI number — VALDEZ FAMILY CLINIC, P.A.

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1215350954 NPI number — VALDEZ FAMILY CLINIC, P.A.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
VALDEZ FAMILY CLINIC, 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:
ALLIANCE FOR WELLNESS, P.A.
Provider Other Organization Name Type Code:
3
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:
1215350954
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
02/03/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
98 BRIGGS ST
Provider Second Line Business Mailing Address:
SUITE 800
Provider Business Mailing Address City Name:
SAN ANTONIO
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
78224-1286
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
210-927-9500
Provider Business Mailing Address Fax Number:
210-927-9200

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
7940 FLOYD CURL DR
Provider Second Line Business Practice Location Address:
SUITE 520
Provider Business Practice Location Address City Name:
SAN ANTONIO
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
78229-3905
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
210-614-4882
Provider Business Practice Location Address Fax Number:
210-614-5386
Provider Enumeration Date:
01/31/2014

Additional Information

Authorized Official

Authorized Official Last Name:
VALDEZ
Authorized Official First Name:
ALICIA
Authorized Official Middle Name:
VARA
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
210-927-9500

Provider Taxonomy Codes

  • Taxonomy code: 207Q00000X , with the licence number:  L1770 , 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)

  • Identifier: 182658801 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".




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