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NPI Code Detail

MEDICARE: VIDA Y SALUD-HEALTH SYSTEMS INC

MEDICARE: VIDA Y SALUD-HEALTH SYSTEMS INC
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
1261QF0400XFederally Qualified Health Center (FQHC)

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1770511032
Entity Type Code : Organization
Provider Name (Legal Business Name) : VIDA Y SALUD-HEALTH SYSTEMS INC
Provider Business Mailing Address
First Line : 308 S CESAR CHAVEZ AVE
Second Line :
City : CRYSTAL CITY
State : TX
Zip : 78839-4200
Country : US
Telephone Number : 830-374-2301
Fax Number : 830-374-9368
Provider Business Practice Location Address
First Line : 308 S CESAR CHAVEZ AVE
Second Line :
City : CRYSTAL CITY
State : TX
Zip : 78839-4200
Country : US
Telephone Number : 830-374-2301
Fax Number : 830-374-9368
Authorized Official
Title or Position : CHIEF EXECUTIVE OFFICER
Name : MRS. NORA TELLEZ
Credential : CEO
Telephone Number : 830-374-2301
Provider Enumeration Date : 06/28/2006
Last Update Date : 07/06/2015

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308 S CESAR CHAVEZ AVE
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Practice Fax: 830-374-3364
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1841383908 — STEVEN PAUL GARZA P.A.
Practice Location Address:
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1023215159 — OLUYEMISI LADITAN D.D.S
Practice Location Address:
308 S CESAR CHAVEZ AVE
CRYSTAL CITY, TX
78839-4200
Practice Phone: 830-374-2301
Practice Fax: 830-374-9368

Directions to “VIDA Y SALUD-HEALTH SYSTEMS INC ” Practice Location

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