=====================================================
General NPI Number Information
=====================================================
NPI Number | 1003105578
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | DILLON'S TLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/05/2011
-----------------------------------------------------
Last Update Date | 04/05/2011
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 711 N MAIN ST SUITE A
-----------------------------------------------------
City | BOERNE
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 78006-1623
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 210-685-8898
-----------------------------------------------------
Fax | 830-537-3535
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 711 N MAIN ST SUITE A
-----------------------------------------------------
City | BOERNE
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 78006-1623
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 210-685-8898
-----------------------------------------------------
Fax | 830-537-3535
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER/PRESIDENT
-----------------------------------------------------
Name | JACQUELINE PONCE VALADEZ
-----------------------------------------------------
Credential | PH.D.
-----------------------------------------------------
Telephone | 210-685-8898
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 225500000X
-----------------------------------------------------
Taxonomy Name | Respiratory/Developmental/Rehabilitative Specialist/Technologist
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------