Healthcare Provider Details

I. General information

NPI: 1346296332
Provider Name (Legal Business Name): VILLA DE NINOS PEDIATRIC REHABILITATION CENTER, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/25/2006
Last Update Date: 04/07/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1757 GEORGE DIETER DR SUITE 125
EL PASO TX
79936-4948
US

IV. Provider business mailing address

2440 E HWY 290 SUITE A-2
DRIPPING SPRINGS TX
78620-4251
US

V. Phone/Fax

Practice location:
  • Phone: 915-591-3336
  • Fax:
Mailing address:
  • Phone: 512-858-9580
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QR0400X
TaxonomyRehabilitation Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MR. RICK OLIVAS
Title or Position: OWNER
Credential:
Phone: 512-858-9580