Provider Demographics
NPI:1003105578
Name:DILLON'S TLC
Entity Type:Organization
Organization Name:DILLON'S TLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JACQUELINE
Authorized Official - Middle Name:PONCE
Authorized Official - Last Name:VALADEZ
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:210-685-8898
Mailing Address - Street 1:711 N MAIN ST
Mailing Address - Street 2:SUITE A
Mailing Address - City:BOERNE
Mailing Address - State:TX
Mailing Address - Zip Code:78006-1623
Mailing Address - Country:US
Mailing Address - Phone:210-685-8898
Mailing Address - Fax:830-537-3535
Practice Address - Street 1:711 N MAIN ST
Practice Address - Street 2:SUITE A
Practice Address - City:BOERNE
Practice Address - State:TX
Practice Address - Zip Code:78006-1623
Practice Address - Country:US
Practice Address - Phone:210-685-8898
Practice Address - Fax:830-537-3535
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-04-05
Last Update Date:2011-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225500000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistGroup - Multi-Specialty