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General NPI Number Information
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NPI Number | 1700176328
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Entity Type | Organization
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Legal Business Name | SAMUELS VALLEY PEDIATRIC SERVICES, PLLC
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Dates
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Enumeration Date | 04/15/2011
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Last Update Date | 04/15/2011
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Provider Practice Location Address
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Address Line | 1220 E 6TH ST
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City | WESLACO
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State | TX
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Zip | 78596-6420
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Country | US
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Telephone | 956-968-9571
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Fax | 956-973-0978
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Provider Business Mailing Address
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Address Line | 601 TRENTON RD # D-116
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City | MCALLEN
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State | TX
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Zip | 78504-2107
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Country | US
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Telephone | 956-968-9571
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Fax | 956-973-0978
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Authorized Official
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Title or Position | OWNER
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Name | MARTEL GEORGE SAMUELS
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Credential | M.D.
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Telephone | 956-968-9571
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number | N7169
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License Number State | TX
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