Healthcare Provider Details

I. General information

NPI: 1972664613
Provider Name (Legal Business Name): CHILDRENS CLINIC OF DIMMIT AND ZAVALA PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/13/2006
Last Update Date: 01/23/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

403 S 7TH ST
CARRIZO SPRINGS TX
78834-3805
US

IV. Provider business mailing address

403 S 7TH ST
CARRIZO SPRINGS TX
78834-3805
US

V. Phone/Fax

Practice location:
  • Phone: 830-876-9870
  • Fax: 830-876-3661
Mailing address:
  • Phone: 830-876-9870
  • Fax: 830-876-3661

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code261QR1300X
TaxonomyRural Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: ABELARDO SABANGAN DORIA
Title or Position: PRESIDENT
Credential: MD
Phone: 830-876-9870