Provider Demographics
NPI:1225117765
Name:CORAZON DEL VALLE DME LLC
Entity Type:Organization
Organization Name:CORAZON DEL VALLE DME LLC
Other - Org Name:MERIDA HEALTH CARE GROUP
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:RODNEY
Authorized Official - Middle Name:
Authorized Official - Last Name:MESQUIAS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:956-797-3730
Mailing Address - Street 1:1514 S. 77 SUNSHINE STRIP STE 24
Mailing Address - Street 2:
Mailing Address - City:HARLINGEN
Mailing Address - State:TX
Mailing Address - Zip Code:78550-5294
Mailing Address - Country:US
Mailing Address - Phone:956-797-3730
Mailing Address - Fax:956-797-3779
Practice Address - Street 1:1514 S. 77 SUNSHINE STRIP STE 24
Practice Address - Street 2:
Practice Address - City:HARLINGEN
Practice Address - State:TX
Practice Address - Zip Code:78550
Practice Address - Country:US
Practice Address - Phone:956-797-3730
Practice Address - Fax:956-797-3779
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-03
Last Update Date:2017-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX0077358332B00000X, 332BP3500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No332BP3500XSuppliersDurable Medical Equipment & Medical SuppliesParenteral & Enteral Nutrition
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX174153001Medicaid
TX5288160001Medicare ID - Type UnspecifiedPROVIDER NUMBER