Provider Demographics
NPI:1831326016
Name:VALLEY'S KIDS AND TEENS CLINIC, P.A.
Entity type:Organization
Organization Name:VALLEY'S KIDS AND TEENS CLINIC, P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PROVIDER
Authorized Official - Prefix:DR
Authorized Official - First Name:JULIO
Authorized Official - Middle Name:
Authorized Official - Last Name:ARIAS-VIAUD
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:956-223-2600
Mailing Address - Street 1:PO BOX 67
Mailing Address - Street 2:
Mailing Address - City:SAN JUAN
Mailing Address - State:TX
Mailing Address - Zip Code:78589-0067
Mailing Address - Country:US
Mailing Address - Phone:956-223-2600
Mailing Address - Fax:956-283-8539
Practice Address - Street 1:1110 S STEWART RD
Practice Address - Street 2:SUITE F
Practice Address - City:SAN JUAN
Practice Address - State:TX
Practice Address - Zip Code:78589-5167
Practice Address - Country:US
Practice Address - Phone:956-223-2600
Practice Address - Fax:956-283-8539
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-06-16
Last Update Date:2011-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXM5030208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX203301102Medicaid
TX194295503Medicaid
TX203301101Medicaid
TX203301103Medicaid