Healthcare Provider Details

I. General information

NPI: 1164560454
Provider Name (Legal Business Name): DEL VALLE ISD
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/01/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5301 ROSS RD
DEL VALLE TX
78617-3203
US

IV. Provider business mailing address

5301 ROSS RD SUITE 118
DEL VALLE TX
78617-3203
US

V. Phone/Fax

Practice location:
  • Phone: 512-386-3020
  • Fax: 512-386-3035
Mailing address:
  • Phone: 512-386-3020
  • Fax: 512-386-3035

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251300000X
TaxonomyLocal Education Agency (LEA)
License Number
License Number State

VIII. Authorized Official

Name: KELLY K CROOK
Title or Position: BUSINESS MANAGER
Credential:
Phone: 512-386-3020