Provider Demographics
NPI:1154336733
Name:CLINICA HISPANA II, P.A.
Entity type:Organization
Organization Name:CLINICA HISPANA II, P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:OSCAR
Authorized Official - Middle Name:L
Authorized Official - Last Name:DE VALLE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:713-484-7455
Mailing Address - Street 1:8410 FONDREN RD
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77074-5616
Mailing Address - Country:US
Mailing Address - Phone:713-484-7455
Mailing Address - Fax:713-484-8016
Practice Address - Street 1:8410 FONDREN RD
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77074-5616
Practice Address - Country:US
Practice Address - Phone:713-484-7455
Practice Address - Fax:713-484-8016
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-30
Last Update Date:2018-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1646507-02OtherEPSDT
TX164650701Medicaid
TX164650703Medicaid
TX1154336733OtherNPI
TX1646507-02OtherEPSDT
TXNPI 1669415196OtherOSCAR L. DE VALLE, M.D.
TX0A3403Medicare PIN
TXNPI 1669415196OtherOSCAR L. DE VALLE, M.D.
TX1116402-04Medicaid