1578892907 NPI number — NUESTRA CLINICA DEL VALLE INC

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 1578892907 NPI number — NUESTRA CLINICA DEL VALLE INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
NUESTRA CLINICA DEL VALLE 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:
NUESTRA CLINICA DEL VALLE - RIO GRANDE CITY
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:
1578892907
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/31/2018
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 1689
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
PHARR
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
78577-1630
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
956-787-8915
Provider Business Mailing Address Fax Number:
956-787-2021

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
600 N GARZA ST STE A
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
RIO GRANDE CITY
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
78582
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
956-487-0846
Provider Business Practice Location Address Fax Number:
956-487-0855
Provider Enumeration Date:
12/14/2009

Additional Information

Authorized Official

Authorized Official Last Name:
TORRES
Authorized Official First Name:
MARIA
Authorized Official Middle Name:
L
Authorized Official Title or Position:
CHIEF EXECUTIVE OFFICER
Authorized Official Telephone Number:
956-787-8915

Provider Taxonomy Codes

  • Taxonomy code: 333600000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 3336C0002X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 3336C0003X , with the licence number: 26674 , 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: 2122847 . This is a "PK" identifier . This identifiers is of the category "OTHER".
  • Identifier: 313325801 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".




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