Provider Demographics
NPI:1144580044
Name:SAMUELS VALLEY PEDIATRIC SERVICES
Entity type:Organization
Organization Name:SAMUELS VALLEY PEDIATRIC SERVICES
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MARTEL
Authorized Official - Middle Name:
Authorized Official - Last Name:SAMUELS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:956-283-0566
Mailing Address - Street 1:427 E DURANTA AVE
Mailing Address - Street 2:102
Mailing Address - City:ALAMO
Mailing Address - State:TX
Mailing Address - Zip Code:78516-3407
Mailing Address - Country:US
Mailing Address - Phone:956-702-2444
Mailing Address - Fax:
Practice Address - Street 1:427 E DURANTA AVE
Practice Address - Street 2:102
Practice Address - City:ALAMO
Practice Address - State:TX
Practice Address - Zip Code:78516-3407
Practice Address - Country:US
Practice Address - Phone:956-702-2444
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-05-24
Last Update Date:2012-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXN7169208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty