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General NPI Number Information
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NPI Number | 1316374556
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Entity Type | Organization
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Legal Business Name | NUESTRA CLINICA DEL VALLE INC
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Dates
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Enumeration Date | 10/02/2013
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Last Update Date | 08/31/2018
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Provider Practice Location Address
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Address Line | 201 S LOS EBANOS RD
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City | ALTON
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State | TX
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Zip | 78573
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Country | US
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Telephone | 956-519-1800
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Fax | 956-519-9360
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Provider Business Mailing Address
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Address Line | 201 S LOS EBANOS RD
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City | ALTON
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State | TX
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Zip | 78573-1139
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Country | US
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Telephone | 956-519-1800
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Fax | 956-519-9360
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Authorized Official
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Title or Position | CHIEF EXECUTIVE OFFICER
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Name | MRS. MARIA L TORRES
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Credential | BBA
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Telephone | 956-787-8915
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QF0400X
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Taxonomy Name | Federally Qualified Health Center (FQHC)
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License Number |
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License Number State | TX
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