Organization
PEDIATRIC SPECIALTY RURAL HEALTH CLINIC, LTD.
Active
Organization
PEDIATRIC SPECIALTY RURAL HEALTH CLINIC, LTD.
Active
Other names
Eagle Pass Pediatric Health Clinic
Organization subpart
No
Provider details
NPI number
Authorized official
DEBRA W DE LOS SANTOS BBA (CEO)
(830) 773-1103
Entity
Organization
Contact information
Practice address
710 WILLIAMS ST, EAGLE PASS, TX 78852-5126
(830) 773-1103
(830) 757-8366
Mailing address
710 WILLIAMS ST, EAGLE PASS, TX 78852-5126
(830) 773-1103
(830) 757-8366
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
—
—
261QR1300X
Rural Health Clinic/Center
Primary
F3442
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
121077504
—
TX
Enumeration date
03/09/2007
Last updated
10/07/2025
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