Provider Demographics
NPI:1497470124
Name:RGV KIDS CLINIC PLLC
Entity Type:Organization
Organization Name:RGV KIDS CLINIC PLLC
Other - Org Name:RGV MEDICAL WELLNESS AND IV INFUSION CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:DENNIS
Authorized Official - Middle Name:MADRIAGA
Authorized Official - Last Name:ELEFANTE & MA ALONA LARAWAN JALA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:956-270-4343
Mailing Address - Street 1:1715 W TRENTON RD
Mailing Address - Street 2:
Mailing Address - City:EDINBURG
Mailing Address - State:TX
Mailing Address - Zip Code:78539-1501
Mailing Address - Country:US
Mailing Address - Phone:956-270-4343
Mailing Address - Fax:956-435-0018
Practice Address - Street 1:1715 W. TENTON RD
Practice Address - Street 2:ST. 204
Practice Address - City:EDINBURG
Practice Address - State:TX
Practice Address - Zip Code:78539
Practice Address - Country:US
Practice Address - Phone:956-270-4343
Practice Address - Fax:956-435-0018
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-10-05
Last Update Date:2023-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Multi-Specialty
No261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care