Provider Demographics
NPI:1922246792
Name:VALLEY PALLIATIVE PHYSICIANS GROUP, PA.
Entity Type:Organization
Organization Name:VALLEY PALLIATIVE PHYSICIANS GROUP, PA.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:ABDIAS
Authorized Official - Middle Name:D
Authorized Official - Last Name:ETIENNE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:917-204-6110
Mailing Address - Street 1:13500 E STATE HIGHWAY 107
Mailing Address - Street 2:SUITE 3
Mailing Address - City:EDINBURG
Mailing Address - State:TX
Mailing Address - Zip Code:78542-1876
Mailing Address - Country:US
Mailing Address - Phone:917-204-6110
Mailing Address - Fax:
Practice Address - Street 1:13500 E STATE HIGHWAY 107
Practice Address - Street 2:SUITE 3
Practice Address - City:EDINBURG
Practice Address - State:TX
Practice Address - Zip Code:78542-1876
Practice Address - Country:US
Practice Address - Phone:917-204-6110
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-01-31
Last Update Date:2009-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXN1626207QH0002X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207QH0002XAllopathic & Osteopathic PhysiciansFamily MedicineHospice and Palliative MedicineGroup - Multi-Specialty