Provider Demographics
NPI:1205379583
Name:YDLG
Entity Type:Organization
Organization Name:YDLG
Other - Org Name:BELTONE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:ROSSANA
Authorized Official - Middle Name:YVONNE
Authorized Official - Last Name:MULLER DE LA GARZA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:956-579-8767
Mailing Address - Street 1:1725 BOCA CHICA BLVD APT A
Mailing Address - Street 2:
Mailing Address - City:BROWNSVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:78520-8173
Mailing Address - Country:US
Mailing Address - Phone:956-542-3300
Mailing Address - Fax:
Practice Address - Street 1:1725 BOCA CHICA BLVD APT A
Practice Address - Street 2:
Practice Address - City:BROWNSVILLE
Practice Address - State:TX
Practice Address - Zip Code:78520-8173
Practice Address - Country:US
Practice Address - Phone:956-542-3300
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-11-18
Last Update Date:2016-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX80236332S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332S00000XSuppliersHearing Aid Equipment