| Organization Name: | MISSION VALLEY MEDICAL CLINIC INC |
| NPI Number: | 1053624932 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | AIDA R DE LA VEGA (PRESIDENT) |
| Mailing Address: | 9001 Cashew Dr Ste 900 El Paso |
| State: | TX US |
| Postal Code: | 799072967 |
| Phone Number: | 9158582300 |
| Fax Number: | 9158582302 |
| NPI Enumeration Date: | 07/20/2010 |
| NPI Last Update Date: | 05/20/2011 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 208D00000X |
| License Number: | |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | |
| Taxonomy Type: | Allopathic & Osteopathic Physicians |
| Taxonomy Classification: | General Practice |
| Taxonomy Specialization: | |
| Taxonomy Definition: | |