1083737647 NPI number — AGUIRRE PRACTICE OF MEDICINE

Table of content: (NPI 1083737647)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1083737647 NPI number — AGUIRRE PRACTICE OF MEDICINE

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
AGUIRRE PRACTICE OF MEDICINE
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1083737647
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
01/28/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2515 CASTROVILLE RD
Provider Second Line Business Mailing Address:
STE 103
Provider Business Mailing Address City Name:
SAN ANTONIO
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
78237-3359
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
210-433-0366
Provider Business Mailing Address Fax Number:
210-433-2622

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2515 CASTROVILLE RD
Provider Second Line Business Practice Location Address:
STE 103
Provider Business Practice Location Address City Name:
SAN ANTONIO
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
78237-3359
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
210-433-0366
Provider Business Practice Location Address Fax Number:
210-433-2622
Provider Enumeration Date:
04/09/2007

Additional Information

Authorized Official

Authorized Official Last Name:
SEGURA
Authorized Official First Name:
MICHAEL
Authorized Official Middle Name:
L
Authorized Official Title or Position:
PRACTICE ADMINISTRATOR
Authorized Official Telephone Number:
210-433-0366

Provider Taxonomy Codes

  • Taxonomy code: 208000000X , with the licence number:  G1316 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 160094203 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".
  • Identifier: 160094202 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".




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