Provider Demographics
NPI:1588670277
Name:PARA NINOS DEL VALLE PEDIATRIC HOME HEALTH, PLLC
Entity Type:Organization
Organization Name:PARA NINOS DEL VALLE PEDIATRIC HOME HEALTH, PLLC
Other - Org Name:PARA NINOS DEL VALLE PEDIATRIC HOME HEALTH
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:CAROLINA
Authorized Official - Middle Name:C
Authorized Official - Last Name:GONZALEZ
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:956-626-1385
Mailing Address - Street 1:1650 RUSSELL LN
Mailing Address - Street 2:
Mailing Address - City:SAN BENITO
Mailing Address - State:TX
Mailing Address - Zip Code:78586-7626
Mailing Address - Country:US
Mailing Address - Phone:956-626-1385
Mailing Address - Fax:956-626-1392
Practice Address - Street 1:1650 RUSSELL LN
Practice Address - Street 2:
Practice Address - City:SAN BENITO
Practice Address - State:TX
Practice Address - Zip Code:78586-7626
Practice Address - Country:US
Practice Address - Phone:956-626-1385
Practice Address - Fax:956-626-1392
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-01
Last Update Date:2023-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX009058251E00000X, 251J00000X, 3747P1801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes251E00000XAgenciesHome Health
No251J00000XAgenciesNursing CareGroup - Multi-Specialty
No3747P1801XNursing Service Related ProvidersTechnicianPersonal Care AttendantGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX166106801Medicaid
TX001013756OtherMED DEP CHILD PRGM (MDCP)
TX001013756OtherMED DEP CHILD PRGM (MDCP)