Provider Demographics
NPI:1437407665
Name:M.L. VALENCIA FAMILY LP
Entity Type:Organization
Organization Name:M.L. VALENCIA FAMILY LP
Other - Org Name:VALLEYWIDE DME
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:JORGE
Authorized Official - Middle Name:
Authorized Official - Last Name:ARANGO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:956-783-9112
Mailing Address - Street 1:1103 N RAUL LONGORIA RD
Mailing Address - Street 2:
Mailing Address - City:SAN JUAN
Mailing Address - State:TX
Mailing Address - Zip Code:78589-3600
Mailing Address - Country:US
Mailing Address - Phone:956-783-9112
Mailing Address - Fax:956-787-4586
Practice Address - Street 1:1103 N RAUL LONGORIA RD
Practice Address - Street 2:
Practice Address - City:SAN JUAN
Practice Address - State:TX
Practice Address - Zip Code:78589-3600
Practice Address - Country:US
Practice Address - Phone:956-783-9112
Practice Address - Fax:956-787-4586
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-08-20
Last Update Date:2016-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX3268187-02Medicaid
TX3268187-01Medicaid
TX=========OtherEIN
TX3268187-02Medicaid