Provider Demographics
NPI:1225230352
Name:EL PAVO REAL ADULT DAY CARE INC.
Entity Type:Organization
Organization Name:EL PAVO REAL ADULT DAY CARE INC.
Other - Org Name:OTHER NAME
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CHAIRMAN OF THE BOARD
Authorized Official - Prefix:MR
Authorized Official - First Name:GILBERTO
Authorized Official - Middle Name:
Authorized Official - Last Name:SOTELO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:956-789-0556
Mailing Address - Street 1:963 W US HIGHWAY 83
Mailing Address - Street 2:P O BOX 656
Mailing Address - City:ALAMO
Mailing Address - State:TX
Mailing Address - Zip Code:78516-2529
Mailing Address - Country:US
Mailing Address - Phone:956-783-8560
Mailing Address - Fax:956-702-1608
Practice Address - Street 1:963 W US HIGHWAY 83
Practice Address - Street 2:
Practice Address - City:ALAMO
Practice Address - State:TX
Practice Address - Zip Code:78516-2529
Practice Address - Country:US
Practice Address - Phone:956-783-8560
Practice Address - Fax:956-702-1608
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-01
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX305S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes305S00000XManaged Care OrganizationsPoint of Service