Provider Demographics
NPI:1194345405
Name:UPPER VALLEY FAMILY CLINIC, PLLC
Entity type:Organization
Organization Name:UPPER VALLEY FAMILY CLINIC, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:FAMILY NURSE PRACTITIONER
Authorized Official - Prefix:MRS
Authorized Official - First Name:NILDA
Authorized Official - Middle Name:DIANNE
Authorized Official - Last Name:RODRIGUEZ
Authorized Official - Suffix:
Authorized Official - Credentials:APRN, FNP-C
Authorized Official - Phone:956-609-9339
Mailing Address - Street 1:1156 W MONTE CRISTO RD STE B
Mailing Address - Street 2:
Mailing Address - City:EDINBURG
Mailing Address - State:TX
Mailing Address - Zip Code:78541-4541
Mailing Address - Country:US
Mailing Address - Phone:956-609-9339
Mailing Address - Fax:
Practice Address - Street 1:1156 W MONTE CRISTO RD
Practice Address - Street 2:
Practice Address - City:EDINBURG
Practice Address - State:TX
Practice Address - Zip Code:78541-4541
Practice Address - Country:US
Practice Address - Phone:956-460-5099
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-04-16
Last Update Date:2020-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care