Provider Demographics
NPI:1598009250
Name:SAMUELS VALLEY PROFESSIONAL SERVICES, LLC
Entity Type:Organization
Organization Name:SAMUELS VALLEY PROFESSIONAL SERVICES, LLC
Other - Org Name:PEDIATRICS PLUS CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:MARTEL
Authorized Official - Middle Name:
Authorized Official - Last Name:SAMUELS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:361-673-3111
Mailing Address - Street 1:1449 W DURANTA AVE STE 3
Mailing Address - Street 2:
Mailing Address - City:ALAMO
Mailing Address - State:TX
Mailing Address - Zip Code:78516-2328
Mailing Address - Country:US
Mailing Address - Phone:956-283-0566
Mailing Address - Fax:956-283-0730
Practice Address - Street 1:102 BABCOCK RD STE 100
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78201-3952
Practice Address - Country:US
Practice Address - Phone:361-673-3111
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-11-19
Last Update Date:2012-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty