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General NPI Number Information
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NPI Number | 1598009250
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Entity Type | Organization
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Legal Business Name | SAMUELS VALLEY PROFESSIONAL SERVICES, LLC
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Dates
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Enumeration Date | 11/19/2012
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Last Update Date | 11/19/2012
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Provider Practice Location Address
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Address Line | 102 BABCOCK RD STE 100
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City | SAN ANTONIO
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State | TX
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Zip | 78201-3952
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Country | US
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Telephone | 361-673-3111
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Fax |
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Provider Business Mailing Address
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Address Line | 1449 W DURANTA AVE STE 3
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City | ALAMO
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State | TX
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Zip | 78516-2328
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Country | US
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Telephone | 956-283-0566
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Fax | 956-283-0730
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Authorized Official
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Title or Position | DIRECTOR
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Name | DR. MARTEL SAMUELS
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Credential | MD
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Telephone | 361-673-3111
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208000000X
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Taxonomy Name | Pediatrics Physician
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License Number |
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License Number State |
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