Provider Demographics
NPI:1083904965
Name:DEPARTMENT OF STATE HEALTH SERVICES
Entity Type:Organization
Organization Name:DEPARTMENT OF STATE HEALTH SERVICES
Other - Org Name:CHILDHOOD LEAD POISONING PREVENTION PROGRAM
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ASSISTANT COMMISSIONER, PREVENTION
Authorized Official - Prefix:DR
Authorized Official - First Name:ADOLFO
Authorized Official - Middle Name:
Authorized Official - Last Name:VALADEZ
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:512-458-7111
Mailing Address - Street 1:PO BOX 149347
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78714-9347
Mailing Address - Country:US
Mailing Address - Phone:512-458-7111
Mailing Address - Fax:512-776-7699
Practice Address - Street 1:1100 W 49TH ST
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78756-3101
Practice Address - Country:US
Practice Address - Phone:512-458-7111
Practice Address - Fax:512-776-7699
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:DEPARTMENT OF STATE HEALTH SERVICES
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2011-04-13
Last Update Date:2011-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251K00000XAgenciesPublic Health or Welfare