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General NPI Number Information
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NPI Number | 1225230352
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Entity Type | Organization
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Legal Business Name | EL PAVO REAL ADULT DAY CARE INC.
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Dates
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Enumeration Date | 06/01/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 963 W US HIGHWAY 83
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City | ALAMO
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State | TX
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Zip | 78516-2529
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Country | US
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Telephone | 956-783-8560
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Fax | 956-702-1608
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Provider Business Mailing Address
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Address Line | 963 W US HIGHWAY 83 P O BOX 656
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City | ALAMO
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State | TX
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Zip | 78516-2529
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Country | US
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Telephone | 956-783-8560
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Fax | 956-702-1608
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Authorized Official
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Title or Position | CHAIRMAN OF THE BOARD
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Name | MR. GILBERTO SOTELO
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Credential |
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Telephone | 956-789-0556
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 305S00000X
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Taxonomy Name | Point of Service
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License Number |
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License Number State | TX
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