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General NPI Number Information
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NPI Number | 1467562728
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Entity Type | Organization
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Legal Business Name | WEST VALLEY RADIOLOGY
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Dates
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Enumeration Date | 08/30/2006
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Last Update Date | 11/02/2007
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Provider Practice Location Address
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Address Line | 1401 E 8TH ST
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City | WESLACO
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State | TX
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Zip | 78596-6640
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Country | US
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Telephone | 956-581-0303
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Fax |
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Provider Business Mailing Address
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Address Line | 2121 E GRIFFIN PKWY #12
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City | MISSION
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State | TX
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Zip | 78572-3241
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Country | US
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Telephone | 956-581-0303
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | MICHAEL DECANDIA
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Credential | M.D.
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Telephone | 956-581-0303
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2085R0202X
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Taxonomy Name | Diagnostic Radiology Physician
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License Number |
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License Number State |
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