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General NPI Number Information
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NPI Number | 1922246792
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Entity Type | Organization
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Legal Business Name | VALLEY PALLIATIVE PHYSICIANS GROUP, PA.
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Dates
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Enumeration Date | 01/31/2009
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Last Update Date | 08/11/2009
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Provider Practice Location Address
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Address Line | 13500 E STATE HIGHWAY 107 SUITE 3
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City | EDINBURG
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State | TX
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Zip | 78542-1876
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Country | US
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Telephone | 917-204-6110
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Fax |
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Provider Business Mailing Address
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Address Line | 13500 E STATE HIGHWAY 107 SUITE 3
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City | EDINBURG
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State | TX
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Zip | 78542-1876
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Country | US
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Telephone | 917-204-6110
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | ABDIAS D ETIENNE
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Credential | M.D
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Telephone | 917-204-6110
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207QH0002X
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Taxonomy Name | Hospice and Palliative Medicine (Family Medicine) Physician
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License Number | N1626
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License Number State | TX
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