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General NPI Number Information
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NPI Number | 1144580044
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Entity Type | Organization
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Legal Business Name | SAMUELS VALLEY PEDIATRIC SERVICES
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Dates
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Enumeration Date | 05/24/2012
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Last Update Date | 05/24/2012
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Provider Practice Location Address
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Address Line | 427 E DURANTA AVE 102
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City | ALAMO
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State | TX
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Zip | 78516-3407
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Country | US
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Telephone | 956-702-2444
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Fax |
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Provider Business Mailing Address
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Address Line | 427 E DURANTA AVE 102
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City | ALAMO
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State | TX
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Zip | 78516-3407
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Country | US
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Telephone | 956-702-2444
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | MARTEL SAMUELS
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Credential | MD
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Telephone | 956-283-0566
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208000000X
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Taxonomy Name | Pediatrics Physician
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License Number | N7169
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License Number State | TX
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