Provider Demographics
NPI:1164642914
Name:PRESTIGE PROVIDER SERVICES INC
Entity Type:Organization
Organization Name:PRESTIGE PROVIDER SERVICES INC
Other - Org Name:PRESTIGE HEALTH SERVICES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:DAN
Authorized Official - Middle Name:
Authorized Official - Last Name:VELAZQUEZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:956-664-9444
Mailing Address - Street 1:5219 S MCCOLL RD STE A
Mailing Address - Street 2:
Mailing Address - City:EDINBURG
Mailing Address - State:TX
Mailing Address - Zip Code:78539-4806
Mailing Address - Country:US
Mailing Address - Phone:956-664-9444
Mailing Address - Fax:956-631-0580
Practice Address - Street 1:5219 S MCCOLL RD STE A
Practice Address - Street 2:
Practice Address - City:EDINBURG
Practice Address - State:TX
Practice Address - Zip Code:78539-4806
Practice Address - Country:US
Practice Address - Phone:956-664-9444
Practice Address - Fax:956-631-0580
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-26
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health