Provider Demographics
NPI:1609814037
Name:LE SALVEO CARE CORP
Entity Type:Organization
Organization Name:LE SALVEO CARE CORP
Other - Org Name:SALVEO FAMILY CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JACQUELINE
Authorized Official - Middle Name:NGA
Authorized Official - Last Name:LE
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:214-509-3623
Mailing Address - Street 1:614 S. WATTERS RD.
Mailing Address - Street 2:SUITE 101
Mailing Address - City:ALLEN
Mailing Address - State:TX
Mailing Address - Zip Code:75013-4732
Mailing Address - Country:US
Mailing Address - Phone:214-509-3623
Mailing Address - Fax:214-509-3620
Practice Address - Street 1:614 S. WATTERS RD.
Practice Address - Street 2:SUITE 101
Practice Address - City:ALLEN
Practice Address - State:TX
Practice Address - Zip Code:75013-4732
Practice Address - Country:US
Practice Address - Phone:214-509-3623
Practice Address - Fax:214-509-3620
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-04
Last Update Date:2010-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXL5017208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX175303001Medicaid
TX175303001Medicaid
00580YMedicare PIN