MEDICARE: CHILDRENS CLINIC OF DIMMIT AND ZAVALA PA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	208000000X	Pediatrics Physician

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	488962	OTHER	TX	MEDICARE PART B

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	0021DU	OTHER	TX	BCBS

General Provider Information

NPI Number	:	1356352827
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CHILDRENS CLINIC OF DIMMIT AND ZAVALA PA

Provider Business Mailing Address
First Line	:	403 S 7TH ST
Second Line	:
City	:	CARRIZO SPRINGS
State	:	TX
Zip	:	78834-3805
Country	:	US
Telephone Number	:	830-876-9870
Fax Number	:	830-876-3661

Provider Business Practice Location Address
First Line	:	1313 VETERANS AVENUE
Second Line	:	SUITE C
City	:	CRYSTAL CITY
State	:	TX
Zip	:	78839
Country	:	US
Telephone Number	:	830-374-4436
Fax Number	:	830-374-4437

Authorized Official
Title or Position	:	PRESIDENT
Name	:	ABELARDO SABANGAN DORIA
Credential	:	MD
Telephone Number	:	830-876-9870

Provider Enumeration Date	:	08/10/2006
Last Update Date	:	02/03/2026

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Directions to “CHILDRENS CLINIC OF DIMMIT AND ZAVALA PA ” Practice Location

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