Pediatric Specialty Rural Health Clinic, LTD.

Primary specialty

Rural Health Clinic/CenterTaxonomy code 261QR1300X

License

F3442 Issued in TX

Legal business name

PEDIATRIC SPECIALTY RURAL HEALTH CLINIC, LTD.

Practice address

710 Williams St
Eagle Pass, TX 78852-5126

Phone

(830) 773-1103

Fax

(830) 757-8366

NPI assigned

Mar 9, 2007

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Debra W De Los Santos, BBA

Title

Ceo

Phone

(830) 773-1103

Specialties & licenses 2

Addresses

Other identifiers 1

Other names 1

• Eagle Pass Pediatric Health Clinic Doing business as

Medicare fee-for-service enrollment

Enrolled in TX

Enrollment records 1

Rural health clinic certification: CCN 453819

Legal name

PEDIATRIC SPECIALTY RURAL HEALTH CLINIC LTD

Doing business as

EAGLE PASS PEDIATRIC HEALTH CLINIC

Certification status

Active

Provider type (POS)

Rural health clinic

Participating since

Apr 23, 1991

Last certification

Jun 1, 2022

Ownership / control type

1A

Most recent change of ownership

Oct 15, 1999 (1 total)

Organization structure

PartnershipProprietary

Incorporated

May 11, 1994 in TX

Enrollment address

710 Williams St
Eagle Pass, TX 78852-5126

Tax ID family

Eagle Pass Ped HLTH Clinic2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

Organizations that report the same tax identification number in the National Provider Directory.

• Eagle Pass Pediatric Health Clinic

  • Rural Health Clinic/Center
  • Eagle Pass, TX
  • NPI 1043472780
  NPD tax ID

Locations

All disclosed owners & managing parties 3

As disclosed on the Medicare enrollment (CMS All Owners files). Individuals include officers, directors and managing employees, who may not hold ownership.

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Ricardo De Los Santos, M.D.

  • Pediatrics Physician
  • Eagle Pass, TX
  • NPI 1790990802
  NPD (past)
• Valeria Fernanda Garza

  • Medical Physician Assistant
  • Eagle Pass, TX
  • NPI 1114659026
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1173398400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1759795200000",
    "number": "1104958081",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "710 WILLIAMS ST",
            "city": "EAGLE PASS",
            "state": "TX",
            "postal_code": "788525126",
            "telephone_number": "830-773-1103",
            "fax_number": "830-757-8366"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "710 WILLIAMS ST",
            "city": "EAGLE PASS",
            "state": "TX",
            "postal_code": "788525126",
            "telephone_number": "830-773-1103",
            "fax_number": "830-757-8366"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PEDIATRIC SPECIALTY RURAL HEALTH CLINIC, LTD.",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-03-09",
        "last_updated": "2025-10-07",
        "certification_date": "2025-10-07",
        "status": "A",
        "authorized_official_last_name": "DE LOS SANTOS",
        "authorized_official_first_name": "DEBRA",
        "authorized_official_middle_name": "W",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "830-773-1103",
        "authorized_official_credential": "BBA"
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Pediatrics",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "261QR1300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rural Health",
            "state": "TX",
            "license": "F3442",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "121077504",
            "state": "TX"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Eagle Pass Pediatric Health Clinic",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Sebastian Padron, MD
• Brenda J Paris, MD
• Patient Solutions LLC
• Peakform Chiropractic & Rehab LLC
• Pediatric Specialty Rural Health Clinic
• Pediatric Specialty Rural Health Clinic,LTD
• Luis Enrique Perales
• Rosa I Perez, F.N.P.
• Victor Manuel Perez
• Performance Therapeutics - Eagle Pass PLLC

• Rural Health Clinic/Center in Eagle Pass, TX
• Providers in Eagle Pass, TX by specialty
• Rural Health Clinic/Center in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 7, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; facility enrollments, owners and changes of ownership; Provider of Services certification data.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.