Healthcare Provider Details

I. General information

NPI: 1700795820
Provider Name (Legal Business Name): NUESTRA CLINICA DEL VALLE, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/03/2026
Last Update Date: 09/03/2026
Certification Date: 09/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1518 SANTA ROSA AVE
EDCOUCH TX
78538-2158
US

IV. Provider business mailing address

PO BOX 1689
PHARR TX
78577-1630
US

V. Phone/Fax

Practice location:
  • Phone: 956-262-1363
  • Fax: 956-262-1840
Mailing address:
  • Phone: 956-787-8915
  • Fax: 956-787-2021

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336C0002X
TaxonomyClinic Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: LAZARO GONZALEZ
Title or Position: BILLING SUPERVISOR
Credential: BBA
Phone: 956-787-8915