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General NPI Number Information
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NPI Number | 1639593577
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Entity Type | Organization
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Legal Business Name | LOS ALAMOS PEDIATRIC SERVICES PA
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Dates
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Enumeration Date | 02/12/2014
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Last Update Date | 02/12/2014
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Provider Practice Location 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 |
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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 |
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. MARTEL SAMUELS
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Credential | M.D.
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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 | 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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