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General NPI Number Information
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NPI Number | 1194816579
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Entity Type | Organization
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Legal Business Name | GUADALUPE VALLEY NEUROLOGY AND ELECTRODIAGNOSTICS,P A
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Dates
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Enumeration Date | 09/28/2006
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Last Update Date | 04/16/2021
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Provider Practice Location Address
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Address Line | 634 E COURT ST STE 102
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City | SEGUIN
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State | TX
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Zip | 78155-5725
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Country | US
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Telephone | 830-303-1819
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Fax |
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Provider Business Mailing Address
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Address Line | 115 GALLERY CIR STE 300
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City | SAN ANTONIO
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State | TX
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Zip | 78258-3389
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Country | US
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Telephone | 210-403-2074
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Fax | 210-403-2078
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Authorized Official
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Title or Position | OFFICE MANAGER
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Name | MS. VIRGINIA MALDONADO
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Credential |
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Telephone | 210-403-2074
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number | J7226
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License Number State | TX
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