Provider Demographics
NPI:1003979402
Name:SANCHEZ, SAMUEL VALLEJO
Entity Type:Individual
Prefix:MR
First Name:SAMUEL
Middle Name:VALLEJO
Last Name:SANCHEZ
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:502 W RAILROAD ST
Mailing Address - Street 2:
Mailing Address - City:WESLACO
Mailing Address - State:TX
Mailing Address - Zip Code:78596-5942
Mailing Address - Country:US
Mailing Address - Phone:956-969-8786
Mailing Address - Fax:956-969-8954
Practice Address - Street 1:502 W RAILROAD ST
Practice Address - Street 2:
Practice Address - City:WESLACO
Practice Address - State:TX
Practice Address - Zip Code:78596-5942
Practice Address - Country:US
Practice Address - Phone:956-969-8786
Practice Address - Fax:956-969-8954
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-18
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX115585261QA0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA0600XAmbulatory Health Care FacilitiesClinic/CenterAdult Day Care