Healthcare Provider Details

I. General information

NPI: 1821489956
Provider Name (Legal Business Name): PALM VALLEY MEDICAL CLINIC PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/11/2015
Last Update Date: 07/22/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5112 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 Code207QS1201X
TaxonomySleep Medicine (Family Medicine) Physician
License NumberH6387
License Number StateTX

VIII. Authorized Official

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