Provider Demographics
NPI:1346487972
Name:ALEJANDRO D. KUDISCH M.D., PA
Entity Type:Organization
Organization Name:ALEJANDRO D. KUDISCH M.D., PA
Other - Org Name:VALLEY FAMILY GUIDANCE CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PSYCHISCIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:ALEJANDRO
Authorized Official - Middle Name:D
Authorized Official - Last Name:KUDISCH
Authorized Official - Suffix:
Authorized Official - Credentials:MD, DFAPA
Authorized Official - Phone:956-687-3000
Mailing Address - Street 1:110 EAST SAVANNAH
Mailing Address - Street 2:BLDG B -201
Mailing Address - City:MCALLEN
Mailing Address - State:TEXAS
Mailing Address - Zip Code:78503-1291
Mailing Address - Country:UM
Mailing Address - Phone:956-687-3000
Mailing Address - Fax:956-687-7948
Practice Address - Street 1:110 E SAVANNAH AVE
Practice Address - Street 2:BLDG B -201
Practice Address - City:MCALLEN
Practice Address - State:TX
Practice Address - Zip Code:78503-1241
Practice Address - Country:US
Practice Address - Phone:956-687-3000
Practice Address - Fax:956-687-7948
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-01-20
Last Update Date:2009-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXJ75462084P0800X, 2084P0804X, 2084P0805X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0804XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyChild & Adolescent PsychiatryGroup - Single Specialty
No2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Single Specialty
No2084P0805XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyGeriatric PsychiatryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX133177905Medicaid
TX00U35NMedicare UPIN