Provider Demographics
NPI:1528235132
Name:UPPER VALLEY PEDIATRIC AND ADOLESCENT HEALTHCARE CLINIC PA
Entity type:Organization
Organization Name:UPPER VALLEY PEDIATRIC AND ADOLESCENT HEALTHCARE CLINIC PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ROEL
Authorized Official - Middle Name:ESTEBAN
Authorized Official - Last Name:CANTU
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:956-787-8100
Mailing Address - Street 1:PO BOX 2419
Mailing Address - Street 2:
Mailing Address - City:SAN JUAN
Mailing Address - State:TX
Mailing Address - Zip Code:78589-7419
Mailing Address - Country:US
Mailing Address - Phone:956-787-8100
Mailing Address - Fax:956-787-8117
Practice Address - Street 1:411 WEST FM 495
Practice Address - Street 2:
Practice Address - City:SAN JUAN
Practice Address - State:TX
Practice Address - Zip Code:78589-7419
Practice Address - Country:US
Practice Address - Phone:956-787-8100
Practice Address - Fax:956-787-8117
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-05-13
Last Update Date:2010-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty