Provider Demographics
NPI:1164899654
Name:VALLEY NEIGHBORHOOD PEDIATRICS
Entity Type:Organization
Organization Name:VALLEY NEIGHBORHOOD PEDIATRICS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PEDIATRICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:INEMESIT
Authorized Official - Middle Name:EPHRAIM
Authorized Official - Last Name:UDOR
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:956-213-8494
Mailing Address - Street 1:2931 LAKE SHORE HARBOUR DR
Mailing Address - Street 2:
Mailing Address - City:MISSOURI CITY
Mailing Address - State:TX
Mailing Address - Zip Code:77459-7623
Mailing Address - Country:US
Mailing Address - Phone:917-204-1954
Mailing Address - Fax:
Practice Address - Street 1:3604 BUDDY OWENS AVE
Practice Address - Street 2:
Practice Address - City:MCALLEN
Practice Address - State:TX
Practice Address - Zip Code:78504-5201
Practice Address - Country:US
Practice Address - Phone:956-213-8494
Practice Address - Fax:956-213-8492
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-08-31
Last Update Date:2015-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXK6377261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care