Basic Information
| Provider Information | |||||||||
| NPI: | 1659405405 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | VALLEY CARE CLINICS | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1400 TRENTON AVE. | ||||||||
| Address2: | |||||||||
| City: | EDINBURG | ||||||||
| State: | TX | ||||||||
| PostalCode: | 785393413 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9563882187 | ||||||||
| FaxNumber: | 9562895375 | ||||||||
| Practice Location | |||||||||
| Address1: | 1400 TRENTON AVE. | ||||||||
| Address2: | |||||||||
| City: | EDINBURG | ||||||||
| State: | TX | ||||||||
| PostalCode: | 785393413 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9563882187 | ||||||||
| FaxNumber: | 9562895375 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/15/2007 | ||||||||
| LastUpdateDate: | 10/02/2012 | ||||||||
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| AuthorizedOfficialLastName: | RODRIGUEZ | ||||||||
| AuthorizedOfficialFirstName: | JESUS | ||||||||
| AuthorizedOfficialMiddleName: | GUILLERMO | ||||||||
| AuthorizedOfficialTitleorPosition: | OWNER | ||||||||
| AuthorizedOfficialTelephone: | 9563882187 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
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| AuthorizedOfficialCredential: | MD | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2081P2900X | J4999 | TX | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Physical Medicine & Rehabilitation | Pain Medicine |
ID Information
| ID | Type | State | Issuer | Description | 161677301 | 05 | TX | MEDICAID | 58HG | 01 | TX | GROUP FOR BLUE CROSS BS | OTHER |