Provider Demographics
NPI: | 1760056337 |
---|---|
Name: | VALORA MEDICAL MANAGEMENT |
Entity Type: | Organization |
Organization Name: | VALORA MEDICAL MANAGEMENT |
Other - Org Name: | |
Other - Org Type: | |
Authorized Official - Title/Position: | COO |
Authorized Official - Prefix: | MRS |
Authorized Official - First Name: | PATRICIA |
Authorized Official - Middle Name: | |
Authorized Official - Last Name: | PICHARDO |
Authorized Official - Suffix: | |
Authorized Official - Credentials: | |
Authorized Official - Phone: | 407-460-1292 |
Mailing Address - Street 1: | 1250 E PIONEER PKWY |
Mailing Address - Street 2: | |
Mailing Address - City: | ARLINGTON |
Mailing Address - State: | TX |
Mailing Address - Zip Code: | 76010-6422 |
Mailing Address - Country: | US |
Mailing Address - Phone: | 844-825-6724 |
Mailing Address - Fax: | |
Practice Address - Street 1: | 1004 S CARRIER PKWY |
Practice Address - Street 2: | |
Practice Address - City: | GRAND PRAIRIE |
Practice Address - State: | TX |
Practice Address - Zip Code: | 75051-1527 |
Practice Address - Country: | US |
Practice Address - Phone: | 844-825-6724 |
Practice Address - Fax: | |
EIN: | <UNAVAIL> |
Is Organization Subpart?: | No |
Parent Organization LBN: | |
Parent Organization TIN: | |
Enumeration Date: | 2021-05-18 |
Last Update Date: | 2021-05-18 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization | Group |
---|---|---|---|---|---|
Yes | 261QP2300X | Ambulatory Health Care Facilities | Clinic/Center | Primary Care | |
No | 207R00000X | Allopathic & Osteopathic Physicians | Internal Medicine | Group - Single Specialty |