Healthcare Provider Details

I. General information

NPI: 1770511032
Provider Name (Legal Business Name): VIDA Y SALUD-HEALTH SYSTEMS INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/28/2006
Last Update Date: 07/06/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

308 S CESAR CHAVEZ AVE
CRYSTAL CITY TX
78839-4200
US

IV. Provider business mailing address

308 S CESAR CHAVEZ AVE
CRYSTAL CITY TX
78839-4200
US

V. Phone/Fax

Practice location:
  • Phone: 830-374-2301
  • Fax: 830-374-9368
Mailing address:
  • Phone: 830-374-2301
  • Fax: 830-374-9368

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QF0400X
TaxonomyFederally Qualified Health Center (FQHC)
License Number
License Number State

VIII. Authorized Official

Name: MRS. NORA TELLEZ
Title or Position: CHIEF EXECUTIVE OFFICER
Credential: CEO
Phone: 830-374-2301