1629815477 NPI number — MR. STEVEN JUAQUIN ANZALDUA FNP

Table of content: MR. STEVEN JUAQUIN ANZALDUA FNP (NPI 1629815477)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1629815477 NPI number — MR. STEVEN JUAQUIN ANZALDUA FNP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
ANZALDUA
Provider First Name:
STEVEN
Provider Middle Name:
JUAQUIN
Provider Name Prefix Text:
MR.
Provider Name Suffix Text:
Provider Credential Text:
FNP
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:
1629815477
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
08/30/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 850
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ALICE
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
78333-0850
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
361-664-0303
Provider Business Mailing Address Fax Number:
866-845-0933

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2701 MORGAN AVENUE
Provider Second Line Business Practice Location Address:
STE 400
Provider Business Practice Location Address City Name:
CORPUS CHRISTI
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
78405-1848
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
361-664-0303
Provider Business Practice Location Address Fax Number:
866-845-0933
Provider Enumeration Date:
07/10/2024

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: 363LF0000X , with the licence number:  1168107 , 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)





Copyright © 2007-2025 www.npivalidator.com