Healthcare Provider Details

I. General information

NPI: 1104057504
Provider Name (Legal Business Name): NUESTRA CLINICA DEL VALLE INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/03/2009
Last Update Date: 08/31/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2891 E GRANT ST
ROMA TX
78584
US

IV. Provider business mailing address

2891 E GRANT ST
ROMA TX
78584-8914
US

V. Phone/Fax

Practice location:
  • Phone: 956-849-2100
  • Fax: 956-787-8915
Mailing address:
  • Phone: 956-849-2100
  • Fax: 956-787-8915

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QF0400X
TaxonomyFederally Qualified Health Center (FQHC)
License Number
License Number State

VIII. Authorized Official

Name: MRS. MARIA L TORRES
Title or Position: CHIEF EXECUTIVE OFFICER
Credential:
Phone: 956-787-8915