1518057983 NPI number — JULIO C OTAZO M.D.

Table of content: JULIO C OTAZO M.D. (NPI 1518057983)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1518057983 NPI number — JULIO C OTAZO M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
OTAZO
Provider First Name:
JULIO
Provider Middle Name:
C
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
M.D.
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:
1518057983
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
05/31/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
8401 DATAPOINT DR STE 600
Provider Second Line Business Mailing Address:
P. O. BOX 29441
Provider Business Mailing Address City Name:
SAN ANTONIO
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
78229-5907
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
210-616-7796
Provider Business Mailing Address Fax Number:
210-616-7799

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
801 N BEDELL AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
DEL RIO
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
78840-4112
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
830-703-1745
Provider Business Practice Location Address Fax Number:
830-774-4599
Provider Enumeration Date:
10/13/2006

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: 2085R0202X , with the licence number:  G6083 , 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: 1356149-15 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1356149-17 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".
  • Identifier: G6083 . This is a "TEXAS MEDICAL LICENSE" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 1356149-16 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".
  • Identifier: 300136080 . This is a "RAILROAD MEDICARE" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 300136181 . This is a "RAILROAD MEDICARE" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".




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