=====================================================
General NPI Number Information
=====================================================
NPI Number | 1568548832
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | CENTRAL VALLEY DME
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/30/2006
-----------------------------------------------------
Last Update Date | 08/22/2020
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1508 E. BUS HWY 83 STE D
-----------------------------------------------------
City | WESLACO
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 78596
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 956-969-2785
-----------------------------------------------------
Fax | 956-969-2780
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1508 E. BUS HWY 83 STE D
-----------------------------------------------------
City | WESLACO
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 78596
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 956-969-2785
-----------------------------------------------------
Fax | 956-969-2780
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | MRS. JUANITA RAMOS
-----------------------------------------------------
Credential | MEDICAL ASST
-----------------------------------------------------
Telephone | 956-969-2785
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 332B00000X
-----------------------------------------------------
Taxonomy Name | Durable Medical Equipment & Medical Supplies
-----------------------------------------------------
License Number | 32020737022
-----------------------------------------------------
License Number State | TX
-----------------------------------------------------