Healthcare Provider Details

I. General information

NPI: 1588731145
Provider Name (Legal Business Name): LA PALOMA DAY HEALTH SERVICES CORP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/29/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

312 E KINNEY ST
CRYSTAL CITY TX
78839-2916
US

IV. Provider business mailing address

1212 N 14TH ST SUITE 3
KINGSVILLE TX
78363-4013
US

V. Phone/Fax

Practice location:
  • Phone: 830-374-5152
  • Fax: 830-374-5193
Mailing address:
  • Phone: 361-592-5222
  • Fax: 361-592-5639

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA0600X
TaxonomyAdult Day Care Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MR. JOE HENRY DELGADO
Title or Position: ACCOUNTANT CORPORATE SECRETARY
Credential:
Phone: 361-592-5222