Provider Demographics
NPI:1992463400
Name:VALLARTA MEDICAL CENTER
Entity type:Organization
Organization Name:VALLARTA MEDICAL CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:DR
Authorized Official - First Name:IAN
Authorized Official - Middle Name:
Authorized Official - Last Name:FISCHMAN
Authorized Official - Suffix:
Authorized Official - Credentials:DR
Authorized Official - Phone:650-417-1127
Mailing Address - Street 1:VALLARTA MEDICAL CENTER
Mailing Address - Street 2:945 MCKINNEY ST #17028
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77002
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:VALLARTA MEDICAL CENTER
Practice Address - Street 2:AV LOS TULES 136
Practice Address - City:PUERTO VALLARTA
Practice Address - State:JALISCO
Practice Address - Zip Code:48310
Practice Address - Country:MX
Practice Address - Phone:322-178-3000
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-12-01
Last Update Date:2021-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282N00000XHospitalsGeneral Acute Care Hospital
Provider Identifiers
StateIdentifier IDID TypeIssuer
MRH200228NP3OtherSTATE