Provider Demographics
NPI:1720618754
Name:DEL VALLE MEDICAL SUPPLY LLC
Entity Type:Organization
Organization Name:DEL VALLE MEDICAL SUPPLY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MARIO
Authorized Official - Middle Name:DANIEL
Authorized Official - Last Name:FLORES
Authorized Official - Suffix:JR
Authorized Official - Credentials:
Authorized Official - Phone:956-627-3338
Mailing Address - Street 1:1510 W DOVE AVE
Mailing Address - Street 2:
Mailing Address - City:MCALLEN
Mailing Address - State:TX
Mailing Address - Zip Code:78504-3439
Mailing Address - Country:US
Mailing Address - Phone:956-627-3338
Mailing Address - Fax:956-627-3487
Practice Address - Street 1:1510 W DOVE AVE
Practice Address - Street 2:
Practice Address - City:MCALLEN
Practice Address - State:TX
Practice Address - Zip Code:78504-3439
Practice Address - Country:US
Practice Address - Phone:956-627-3338
Practice Address - Fax:956-627-3487
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-01-17
Last Update Date:2020-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX198884201Medicaid