Provider Demographics
NPI:1770028326
Name:CORAZON DEL VALLE DME LLC
Entity Type:Organization
Organization Name:CORAZON DEL VALLE DME LLC
Other - Org Name:MERIDA HEALTH CARE GROUP
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:RODNEY
Authorized Official - Middle Name:
Authorized Official - Last Name:MESQUIAS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:956-423-1197
Mailing Address - Street 1:2900 MOSSROCK STE 370
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78230-5161
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2900 MOSSROCK STE 370
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78230-5161
Practice Address - Country:US
Practice Address - Phone:956-797-3730
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-01-05
Last Update Date:2017-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1000541332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies