Provider Demographics
NPI:1053326629
Name:CLINICA HISPANA, P.A.
Entity Type:Organization
Organization Name:CLINICA HISPANA, P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:OSCAR
Authorized Official - Middle Name:L
Authorized Official - Last Name:DE VALLE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:713-682-7066
Mailing Address - Street 1:2028 WIRT RD
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77055-1602
Mailing Address - Country:US
Mailing Address - Phone:713-682-7066
Mailing Address - Fax:832-916-2813
Practice Address - Street 1:2028 WIRT RD
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77055-1602
Practice Address - Country:US
Practice Address - Phone:713-682-7066
Practice Address - Fax:832-916-2813
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-30
Last Update Date:2019-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
No208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX111512302OtherEPSDT
TX111512301Medicaid
TXNPI1316010820OtherNELSON E. UZQUIANO, M.D.
TXNPI1790823037OtherEMILIO B. HISSE, M.D.
TX111512301Medicaid
TXNPI1316984735OtherRICARDO GRILLO-PARIS, M.D.
TX111512302OtherEPSDT
TXNPI1669415196OtherOSCAR L. DE VALLE, M.D.
TXNPI1699712018OtherRODRIGO DE VALLE, M.D.
TX111512301Medicaid