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General NPI Number Information
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NPI Number | 1750528147
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Entity Type | Organization
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Legal Business Name | VALLEY PORTABLE CT SCANS LLC
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Dates
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Enumeration Date | 01/07/2009
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Last Update Date | 02/28/2011
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Provider Practice Location Address
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Address Line | 1615 E LOEB ST
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City | EDINBURG
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State | TX
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Zip | 78542-0627
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Country | US
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Telephone | 956-878-9296
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Fax | 956-661-8005
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Provider Business Mailing Address
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Address Line | 1615 E LOEB ST
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City | EDINBURG
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State | TX
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Zip | 78542-0627
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Country | US
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Telephone | 956-878-9296
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Fax | 956-661-8005
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Authorized Official
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Title or Position | PRESIDENT
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Name | JORGE ORLANDO TREVINO
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Credential | R.T. (R) (ARRT)
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Telephone | 956-878-9296
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 335V00000X
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Taxonomy Name | Portable X-ray and/or Other Portable Diagnostic Imaging Supplier
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License Number | 23843
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License Number State | TX
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