Provider Demographics
NPI:1861829079
Name:NUESTRA CLINICA DEL VALLE INC
Entity Type:Organization
Organization Name:NUESTRA CLINICA DEL VALLE INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:MARIA
Authorized Official - Middle Name:L
Authorized Official - Last Name:TORRES
Authorized Official - Suffix:
Authorized Official - Credentials:BBA
Authorized Official - Phone:956-787-8915
Mailing Address - Street 1:1518 E. SANTA ROSA AVE
Mailing Address - Street 2:
Mailing Address - City:EDCOUCH
Mailing Address - State:TX
Mailing Address - Zip Code:78538-2098
Mailing Address - Country:US
Mailing Address - Phone:956-262-1363
Mailing Address - Fax:956-262-1840
Practice Address - Street 1:1518 E. SANTA ROSA
Practice Address - Street 2:
Practice Address - City:EDCOUCH
Practice Address - State:TX
Practice Address - Zip Code:78538-2098
Practice Address - Country:US
Practice Address - Phone:956-262-1363
Practice Address - Fax:956-262-1840
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-10-02
Last Update Date:2018-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX207Q00000X, 261QF0400X, 363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QF0400XAmbulatory Health Care FacilitiesClinic/CenterFederally Qualified Health Center (FQHC)Group - Multi-Specialty
No207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX019057101Medicaid
TX451807Medicare Oscar/Certification