Provider Demographics
NPI:1891803078
Name:THERESA L.VALLADARES, M.D.P.A.
Entity Type:Organization
Organization Name:THERESA L.VALLADARES, M.D.P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DOCTOR / PHYSICIAN OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:THERESA
Authorized Official - Middle Name:LYNN
Authorized Official - Last Name:VALLADARES
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:956-702-0024
Mailing Address - Street 1:2302 RED RIVER DR
Mailing Address - Street 2:
Mailing Address - City:MISSION
Mailing Address - State:TX
Mailing Address - Zip Code:78572-7454
Mailing Address - Country:US
Mailing Address - Phone:956-702-0024
Mailing Address - Fax:956-702-0616
Practice Address - Street 1:923 E FERGUSON ST
Practice Address - Street 2:SUITE C
Practice Address - City:PHARR
Practice Address - State:TX
Practice Address - Zip Code:78577-2613
Practice Address - Country:US
Practice Address - Phone:956-702-0024
Practice Address - Fax:956-702-0616
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-28
Last Update Date:2011-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX0084PUOtherBCBS GROUP #
TX148012102Medicaid
TX0011MPOtherBCBS PROVIDER #
TX173167101Medicaid
TX173167102Medicaid
TX173167102Medicaid
TXH05149Medicare UPIN
TX8E0396Medicare ID - Type Unspecified
TX00707YMedicare ID - Type Unspecified