=====================================================
General NPI Number Information
=====================================================
NPI Number | 1386685717
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | ALL VALLEY SLEEP CENTER, LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/09/2006
-----------------------------------------------------
Last Update Date | 12/02/2009
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 5511 DOCTORS DR
-----------------------------------------------------
City | EDINBURG
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 78539-5563
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 956-971-5510
-----------------------------------------------------
Fax | 956-971-5509
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 985
-----------------------------------------------------
City | SAN JUAN
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 78589-0985
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 956-702-9700
-----------------------------------------------------
Fax | 956-702-9704
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | CREDENTIALING OFFICER
-----------------------------------------------------
Name | MRS. NELLIE GARCIA
-----------------------------------------------------
Credential | CPC
-----------------------------------------------------
Telephone | 956-342-1632
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 293D00000X
-----------------------------------------------------
Taxonomy Name | Physiological Laboratory
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State | TX
-----------------------------------------------------