Provider Demographics
NPI:1881021541
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:CHIEF EXECUTIVE OFFICER
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:
Authorized Official - Phone:956-787-8915
Mailing Address - Street 1:301 S 17TH ST
Mailing Address - Street 2:
Mailing Address - City:DONNA
Mailing Address - State:TX
Mailing Address - Zip Code:78537-3438
Mailing Address - Country:US
Mailing Address - Phone:956-464-5809
Mailing Address - Fax:956-464-5816
Practice Address - Street 1:105 S 10TH ST
Practice Address - Street 2:
Practice Address - City:DONNA
Practice Address - State:TX
Practice Address - Zip Code:78537-3201
Practice Address - Country:US
Practice Address - Phone:956-464-5809
Practice Address - Fax:956-464-5816
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-09-26
Last Update Date:2019-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX261QF0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QF0400XAmbulatory Health Care FacilitiesClinic/CenterFederally Qualified Health Center (FQHC)
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX160132001Medicaid
TX160132001Medicaid