Healthcare Provider Details

I. General information

NPI: 1053488239
Provider Name (Legal Business Name): EL ORO DEL PUEBLO SERVICES, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/30/2006
Last Update Date: 09/23/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

916 MIKE CHAPA
LA VILLA TX
78562
US

IV. Provider business mailing address

PO BOX 267 916 MIKE CHAPA
WESLACO TX
78599-0267
US

V. Phone/Fax

Practice location:
  • Phone: 956-968-1271
  • Fax: 956-973-9799
Mailing address:
  • Phone: 956-968-1271
  • Fax: 968-973-9799

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA0600X
TaxonomyAdult Day Care Clinic/Center
License Number117281
License Number StateTX

VIII. Authorized Official

Name: MS. BLANCA E GONZALEZ
Title or Position: VICE PRESIDENT
Credential: MSW AP
Phone: 956-968-1271