Healthcare Provider Details

I. General information

NPI: 1558570416
Provider Name (Legal Business Name): PALM VALLEY MEDICAL CLINIC PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/21/2007
Last Update Date: 11/30/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5140 N 10TH ST
MCALLEN TX
78504-2834
US

IV. Provider business mailing address

5140 N 10TH ST
MCALLEN TX
78504-2834
US

V. Phone/Fax

Practice location:
  • Phone: 956-972-1600
  • Fax: 956-972-0880
Mailing address:
  • Phone: 956-972-1600
  • Fax: 956-972-0880

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberH6387
License Number StateTX

VIII. Authorized Official

Name: DR. NOEL LOPEZ
Title or Position: PHYSICIAN OWNER
Credential: MD
Phone: 956-972-1600