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NPI Code Detail

MEDICARE: CLINICA HISPANA II, P.A.

MEDICARE: CLINICA HISPANA II, P.A.
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1261Q00000XClinic/Center

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
11646507-02OTHERTXEPSDT
2MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1154336733
Entity Type Code : Organization
Provider Name (Legal Business Name) : CLINICA HISPANA II, P.A.
Provider Business Mailing Address
First Line : 8410 FONDREN RD
Second Line :
City : HOUSTON
State : TX
Zip : 77074-5616
Country : US
Telephone Number : 713-484-7455
Fax Number : 713-484-8016
Provider Business Practice Location Address
First Line : 8410 FONDREN RD
Second Line :
City : HOUSTON
State : TX
Zip : 77074-5616
Country : US
Telephone Number : 713-484-7455
Fax Number : 713-484-8016
Authorized Official
Title or Position : PHYSICIAN
Name : DR. OSCAR L DE VALLE
Credential : M.D.
Telephone Number : 713-484-7455
Provider Enumeration Date : 07/30/2006
Last Update Date : 04/23/2018

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Directions to “CLINICA HISPANA II, P.A. ” Practice Location

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