Provider Demographics
NPI:1063642411
Name:PROVEDORA DEL VALLE
Entity Type:Organization
Organization Name:PROVEDORA DEL VALLE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:SILVIA
Authorized Official - Middle Name:A
Authorized Official - Last Name:LAHOZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:956-371-6620
Mailing Address - Street 1:1575 US MILITARY HIGHWAY 281
Mailing Address - Street 2:SUITE 204
Mailing Address - City:BROWNSVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:78520-3406
Mailing Address - Country:US
Mailing Address - Phone:956-371-6620
Mailing Address - Fax:
Practice Address - Street 1:1575 US MILITARY HIGHWAY 281
Practice Address - Street 2:SUITE 204
Practice Address - City:BROWNSVILLE
Practice Address - State:TX
Practice Address - Zip Code:78520-3406
Practice Address - Country:US
Practice Address - Phone:956-371-6620
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-07-20
Last Update Date:2009-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies