Basic Information
| Provider Information | |||||||||
| NPI: | 1073644167 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | PALM VALLEY PEDIATRIC SURGEONS PLLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 3823 | ||||||||
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| City: | MCALLEN | ||||||||
| State: | TX | ||||||||
| PostalCode: | 785023823 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9566839399 | ||||||||
| FaxNumber: | 9566839378 | ||||||||
| Practice Location | |||||||||
| Address1: | 510 LINDBERG AVE | ||||||||
| Address2: | |||||||||
| City: | MCALLEN | ||||||||
| State: | TX | ||||||||
| PostalCode: | 785012924 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9566839399 | ||||||||
| FaxNumber: | 9566839378 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/08/2007 | ||||||||
| LastUpdateDate: | 12/17/2007 | ||||||||
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| AuthorizedOfficialLastName: | HERNANDEZ | ||||||||
| AuthorizedOfficialFirstName: | AMBROSIO | ||||||||
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| AuthorizedOfficialTitleorPosition: | PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 9566839399 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | MD | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208600000X | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Surgery |
No ID Information.