Healthcare Provider Details

I. General information

NPI: 1477612174
Provider Name (Legal Business Name): ADOLFO SQUARE INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/08/2006
Last Update Date: 04/29/2024
Certification Date: 04/29/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

515 N. FM 1015
PROGRESO TX
78579
US

IV. Provider business mailing address

RR 6 BOX 535B
EDINBURG TX
78539-8907
US

V. Phone/Fax

Practice location:
  • Phone: 956-565-9105
  • Fax:
Mailing address:
  • Phone: 956-383-4991
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA0600X
TaxonomyAdult Day Care Clinic/Center
License Number003334
License Number StateTX

VIII. Authorized Official

Name: ADOLFO VALADEZ
Title or Position: PRESIDENT
Credential:
Phone: 956-383-4991