1902394513 NPI number — VICTOR ALEJANDRO CANELA SAMANIEGO DO

Table of content: VICTOR ALEJANDRO CANELA SAMANIEGO DO (NPI 1902394513)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1902394513 NPI number — VICTOR ALEJANDRO CANELA SAMANIEGO DO

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
CANELA SAMANIEGO
Provider First Name:
VICTOR
Provider Middle Name:
ALEJANDRO
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
DO
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:
1902394513
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/28/2025
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1505 LBJ FWY STE 700
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
DALLAS
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
75234-6065
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
214-358-2300
Provider Business Mailing Address Fax Number:
214-579-6941

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2900 N I 35 STE 401
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
DENTON
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
76201-5148
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
940-565-9557
Provider Business Practice Location Address Fax Number:
940-226-0206
Provider Enumeration Date:
04/30/2018

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: 207RN0300X , with the licence number:  T2130 , 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: T2130 . This is a "TX MEDICAL LICENSE" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".




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