Provider Demographics
NPI:1053624932
Name:MISSION VALLEY MEDICAL CLINIC INC
Entity type:Organization
Organization Name:MISSION VALLEY MEDICAL CLINIC INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:AIDA
Authorized Official - Middle Name:R
Authorized Official - Last Name:DE LA VEGA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:915-820-9228
Mailing Address - Street 1:9001 CASHEW DR
Mailing Address - Street 2:STE 900
Mailing Address - City:EL PASO
Mailing Address - State:TX
Mailing Address - Zip Code:79907-2967
Mailing Address - Country:US
Mailing Address - Phone:915-820-9228
Mailing Address - Fax:305-388-4380
Practice Address - Street 1:9001 CASHEW DR
Practice Address - Street 2:STE 900
Practice Address - City:EL PASO
Practice Address - State:TX
Practice Address - Zip Code:79907-2967
Practice Address - Country:US
Practice Address - Phone:915-858-2300
Practice Address - Fax:915-858-2302
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-07-20
Last Update Date:2011-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Multi-Specialty