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General NPI Number Information
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NPI Number | 1619218310
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Entity Type | Organization
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Legal Business Name | LAS MILPAS PEDIATRIC SERVICES
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Dates
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Enumeration Date | 03/06/2013
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Last Update Date | 03/06/2013
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Provider Practice Location Address
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Address Line | 204 PALMVIEW DR STE A
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City | PALMVIEW
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State | TX
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Zip | 78572-8176
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Country | US
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Telephone | 956-283-0566
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Fax |
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Provider Business Mailing Address
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Address Line | 1449 W DURANTA AVE 3
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City | ALAMO
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State | TX
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Zip | 78516-2329
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Country | US
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Telephone | 956-283-0566
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Fax |
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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 | 956-283-0566
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | N7169
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License Number State | TX
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