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General NPI Number Information
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NPI Number | 1386660744
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Entity Type | Organization
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Legal Business Name | COMMUNITY MOTHER AND CHILD HEALTH CENTER
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Dates
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Enumeration Date | 07/15/2006
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Last Update Date | 12/06/2010
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Provider Practice Location Address
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Address Line | 510 E RIO GRANDE ST
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City | VICTORIA
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State | TX
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Zip | 77901-6033
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Country | US
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Telephone | 361-570-1083
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Fax |
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Provider Business Mailing Address
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Address Line | 510 E RIO GRANDE ST
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City | VICTORIA
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State | TX
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Zip | 77901-6033
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Country | US
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Telephone | 361-570-1083
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Fax |
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Authorized Official
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Title or Position | MANAGING EMPLOYEE
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Name | JUDY GILLEY
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Credential | FNP
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Telephone | 361-570-1082
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207V00000X
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Taxonomy Name | Obstetrics & Gynecology Physician
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 208D00000X
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Taxonomy Name | General Practice Physician
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License Number |
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License Number State | TX
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