| Organization Name: | UPPER VALLEY MEDICAL CLINIC, PLLC |
| NPI Number: | 1366773947 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | ANNA M LUCERO (OWNER/PRESIDENT) |
| Mailing Address: | 950 Anthony St Canutillo |
| State: | TX US |
| Postal Code: | 798356052 |
| Phone Number: | 9158774217 |
| Fax Number: | 9158774231 |
| NPI Enumeration Date: | 01/21/2010 |
| NPI Last Update Date: | 01/21/2010 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 363LF0000X |
| License Number: | 537539 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | TX |
| Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
| Taxonomy Classification: | Nurse Practitioner |
| Taxonomy Specialization: | Family |
| Taxonomy Definition: | |