Provider Demographics
NPI:1164685467
Name:LA SALUD CLINIC MEDICAL ASSOCIATION
Entity Type:Organization
Organization Name:LA SALUD CLINIC MEDICAL ASSOCIATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:VICTOR HUGO
Authorized Official - Middle Name:VALENCIA
Authorized Official - Last Name:ARELLANO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:281-855-2244
Mailing Address - Street 1:15410 RIDGE PARK DR
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77095
Mailing Address - Country:US
Mailing Address - Phone:281-855-2244
Mailing Address - Fax:281-855-2752
Practice Address - Street 1:15410 RIDGE PARK DR
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77095
Practice Address - Country:US
Practice Address - Phone:281-855-2244
Practice Address - Fax:281-855-2752
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:LA SALUD CLINIC MEDICAL ASSOCIATION
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2008-07-07
Last Update Date:2011-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX753525164W00000X
TXG7777207PE0004X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207PE0004XAllopathic & Osteopathic PhysiciansEmergency MedicineEmergency Medical ServicesGroup - Multi-Specialty
No164W00000XNursing Service ProvidersLicensed Practical NurseGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXTXB11368Medicare UPIN