Provider Demographics
NPI:1982884284
Name:UPPER VALLEY PEDIATRICS, PLLC
Entity Type:Organization
Organization Name:UPPER VALLEY PEDIATRICS, PLLC
Other - Org Name:UNIVERSITY PEDIATRICS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:SERGIO
Authorized Official - Middle Name:GUSTAVO
Authorized Official - Last Name:PRECIADO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:956-787-2500
Mailing Address - Street 1:832 DEL ORO LN
Mailing Address - Street 2:SUITE 2
Mailing Address - City:PHARR
Mailing Address - State:TX
Mailing Address - Zip Code:78577-2200
Mailing Address - Country:US
Mailing Address - Phone:956-787-2500
Mailing Address - Fax:956-787-2528
Practice Address - Street 1:615 E UNIVERSITY DR
Practice Address - Street 2:
Practice Address - City:EDINBURG
Practice Address - State:TX
Practice Address - Zip Code:78539-3626
Practice Address - Country:US
Practice Address - Phone:956-316-4416
Practice Address - Fax:956-316-4434
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-11-05
Last Update Date:2016-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXJ9278208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX195075001Medicaid
TX195075002Medicaid