Provider Demographics
NPI:1528258282
Name:VALLEY MEDICAL ASSOCIATION, P.A.
Entity type:Organization
Organization Name:VALLEY MEDICAL ASSOCIATION, P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:COO
Authorized Official - Prefix:MRS
Authorized Official - First Name:GLORIA
Authorized Official - Middle Name:
Authorized Official - Last Name:GONZALEZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:956-488-1200
Mailing Address - Street 1:201 E 2ND ST
Mailing Address - Street 2:
Mailing Address - City:RIO GRANDE CITY
Mailing Address - State:TX
Mailing Address - Zip Code:78582-3803
Mailing Address - Country:US
Mailing Address - Phone:956-488-1200
Mailing Address - Fax:956-488-9500
Practice Address - Street 1:2271 E GRANT ST
Practice Address - Street 2:
Practice Address - City:ROMA
Practice Address - State:TX
Practice Address - Zip Code:78584-8870
Practice Address - Country:US
Practice Address - Phone:956-849-3100
Practice Address - Fax:956-849-3400
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-30
Last Update Date:2009-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX200056402Medicaid
TX200056401Medicaid
TX200056403Medicaid