Provider Demographics
NPI:1184739179
Name:WALTHAM CONSULTANTS PA
Entity type:Organization
Organization Name:WALTHAM CONSULTANTS PA
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:LORENZO
Authorized Official - Middle Name:M
Authorized Official - Last Name:FAROLAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:956-687-2976
Mailing Address - Street 1:PO BOX 4470
Mailing Address - Street 2:
Mailing Address - City:MCALLEN
Mailing Address - State:TX
Mailing Address - Zip Code:78502-4470
Mailing Address - Country:US
Mailing Address - Phone:956-687-2976
Mailing Address - Fax:956-994-1338
Practice Address - Street 1:2616 CORNERSTONE BLVD
Practice Address - Street 2:
Practice Address - City:EDINBURG
Practice Address - State:TX
Practice Address - Zip Code:78539-9122
Practice Address - Country:US
Practice Address - Phone:956-687-2976
Practice Address - Fax:956-994-1338
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-20
Last Update Date:2011-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXF5201174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX143798001Medicaid
TX00511RMedicare ID - Type UnspecifiedMEDICARE
TXB22638Medicare UPIN