Healthcare Provider Details

I. General information

NPI: 1578321576
Provider Name (Legal Business Name): THE CHILDREN'S CLINIC OF DIMMIT & ZAVALA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/13/2024
Last Update Date: 06/12/2025
Certification Date: 06/12/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1313 VETERANS AVE STE C
CRYSTAL CITY TX
78839-1651
US

IV. Provider business mailing address

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

V. Phone/Fax

Practice location:
  • Phone: 830-374-4436
  • Fax: 830-374-4437
Mailing address:
  • Phone: 830-876-9870
  • Fax: 830-876-3661

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DR. ABELADO S DORIA
Title or Position: DOCTOR
Credential: MD
Phone: 817-876-9870