Provider Demographics
NPI:1093174518
Name:THE LOWER VALLEY PEDIATRIC NIGHT CLINIC, P.A.
Entity Type:Organization
Organization Name:THE LOWER VALLEY PEDIATRIC NIGHT CLINIC, P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:RUBEN
Authorized Official - Middle Name:RAFAEL
Authorized Official - Last Name:RONCALLO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:915-532-9000
Mailing Address - Street 1:4500 N MESA ST
Mailing Address - Street 2:
Mailing Address - City:EL PASO
Mailing Address - State:TX
Mailing Address - Zip Code:79912-6102
Mailing Address - Country:US
Mailing Address - Phone:915-532-9000
Mailing Address - Fax:915-532-9006
Practice Address - Street 1:10211 ALAMEDA AVE
Practice Address - Street 2:
Practice Address - City:SOCORRO
Practice Address - State:TX
Practice Address - Zip Code:79927-1602
Practice Address - Country:US
Practice Address - Phone:915-532-9000
Practice Address - Fax:915-532-9006
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-02-11
Last Update Date:2016-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXK9162208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Multi-Specialty