1346646510 NPI number — MATTHEW ARISMENDEZ PA-C

Table of content: MATTHEW ARISMENDEZ PA-C (NPI 1346646510)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1346646510 NPI number — MATTHEW ARISMENDEZ PA-C

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
ARISMENDEZ
Provider First Name:
MATTHEW
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
PA-C
Provider Gender Code:
M

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:
1346646510
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
01/16/2025
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
7323 MARBACH RD STE 104
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SAN ANTONIO
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
78227-1905
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
210-674-0257
Provider Business Mailing Address Fax Number:
210-674-0257

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
7323 MARBACH RD STE 104
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SAN ANTONIO
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
78227-1905
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
210-674-0257
Provider Business Practice Location Address Fax Number:
210-674-0257
Provider Enumeration Date:
11/14/2014

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 363A00000X , with the licence number:  PA09452 , 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: 741833622 . This is a "GROUP TAX ID#" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 00295N . This is a "MEDICARE GRP#" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 1346646510 . This is a "INDIVIDUAL NPI#" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: PA09452 . This is a "PHYSICIAN ASSISTANT LICENSE #" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 193200000X . This is a "GROUP TAXONOMY" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: PA09452 . This is a "PHYSICIAN ASSISTANT LICENSE" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 1508813494 . This is a "GROUP/BILLING NPI#" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".




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