1326818774 NPI number — SOUTH TEXAS HEALTH ALLIANCE, PLLC.

Table of content: THOMAS M. OTAL M.D. (NPI 1376525709)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1326818774 NPI number — SOUTH TEXAS HEALTH ALLIANCE, PLLC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
SOUTH TEXAS HEALTH ALLIANCE, PLLC.
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:
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Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1326818774
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
01/08/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2582 MAIN ST STE B
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
INGLESIDE
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
78362-6054
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
361-389-3234
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2582 MAIN ST STE B
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
INGLESIDE
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
78362-6054
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
361-389-3234
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
01/08/2024

Additional Information

Authorized Official

Authorized Official Last Name:
RAMIREZ
Authorized Official First Name:
DANIELA
Authorized Official Middle Name:
NIKLOLE
Authorized Official Title or Position:
NURSE PRACTITIONER
Authorized Official Telephone Number:
361-389-3234

Provider Taxonomy Codes

  • Taxonomy code: 207Q00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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