MEDICARE: EL ORO DEL PUEBLO SERVICE INC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QA0600X	Adult Day Care Clinic/Center	115767	TX
2	261QA0600X	Adult Day Care Clinic/Center	117281	TX
3	261QA0600X	Adult Day Care Clinic/Center	117622	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1871822296
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	EL ORO DEL PUEBLO SERVICE INC

Provider Business Mailing Address
First Line	:	P.O. BOX 267
Second Line	:
City	:	WESLAC0
State	:	TX
Zip	:	78599
Country	:	US
Telephone Number	:	956-968-1271
Fax Number	:	956-973-9788

Provider Business Practice Location Address
First Line	:	508 S STANDARD AVE
Second Line	:
City	:	SAN JUAN
State	:	TX
Zip	:	78589-2443
Country	:	US
Telephone Number	:	956-782-1000
Fax Number	:	956-782-1080

Authorized Official
Title or Position	:	VICE PRESIDENT
Name	:	MS. BLANCA E GONZALEZ
Credential	:	MSW AP
Telephone Number	:	956-968-1271

Provider Enumeration Date	:	12/14/2009
Last Update Date	:	12/14/2009

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Directions to “EL ORO DEL PUEBLO SERVICE INC ” Practice Location

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