1710027719 NPI number — WORKERS COMPENSATION ASSISTANCE CLINIC

Table of content: (NPI 1710027719)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1710027719 NPI number — WORKERS COMPENSATION ASSISTANCE CLINIC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
WORKERS COMPENSATION ASSISTANCE CLINIC
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:
1710027719
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/22/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1231 AGNES
Provider Second Line Business Mailing Address:
SUITE A9
Provider Business Mailing Address City Name:
CORPUS CHRISTI
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
78403
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
361-884-8770
Provider Business Mailing Address Fax Number:
361-884-8710

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
5732 WURZBACH RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SAN ANTONIO
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
78238-1747
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
210-521-1244
Provider Business Practice Location Address Fax Number:
210-521-7324
Provider Enumeration Date:
02/07/2007

Additional Information

Authorized Official

Authorized Official Last Name:
VALENZUELA
Authorized Official First Name:
ADAM
Authorized Official Middle Name:
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
210-521-1244

Provider Taxonomy Codes

  • Taxonomy code: 261QR0400X , with the licence number:  F006281 , 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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