Organization Name: | NUESTRA CLINICA DEL VALLE INC |
NPI Number: | 1104057504 |
Entity Type Code: | Organizational (2) |
Authorized Official Name: | MARIA L TORRES (CHIEF EXECUTIVE OFFICER) |
Mailing Address: | 2891 E Grant St Roma |
State: | TX US |
Postal Code: | 785848914 |
Phone Number: | 9568492100 |
Fax Number: | 9567878915 |
NPI Enumeration Date: | 08/03/2009 |
NPI Last Update Date: | 12/15/2015 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 261QF0400X |
License Number: | |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | |
Taxonomy Type: | Ambulatory Health Care Facilities |
Taxonomy Classification: | Clinic/Center |
Taxonomy Specialization: | Federally Qualified Health Center (FQHC) |
Taxonomy Definition: |