Healthcare Provider Details

I. General information

NPI: 1447597653
Provider Name (Legal Business Name): ALTON CHILDRENS CARE CLINIC, P.A.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/08/2013
Last Update Date: 01/08/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8115 NORTH LOS EBANOS ROAD
ALTON TX
78573
US

IV. Provider business mailing address

PO BOX 1820
EDINBURG TX
78540-1820
US

V. Phone/Fax

Practice location:
  • Phone: 956-383-7788
  • Fax: 956-383-7155
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. ALLAN FRANCIS MAUN MERCADO
Title or Position: M.D.
Credential: M.D.
Phone: 956-383-7788