Healthcare Provider Details

I. General information

NPI: 1427084763
Provider Name (Legal Business Name): PAULA VERONICA REQUEIJO M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/25/2006
Last Update Date: 02/18/2025
Certification Date: 02/18/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3901A SPICEWOOD SPRINGS RD SUITE #201
AUSTIN TX
78759-8723
US

IV. Provider business mailing address

3901A SPICEWOOD SPRINGS RD SUITE #201
AUSTIN TX
78759-8723
US

V. Phone/Fax

Practice location:
  • Phone: 737-226-6700
  • Fax: 737-226-6777
Mailing address:
  • Phone: 737-226-6700
  • Fax: 737-226-6777

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number71751
License Number StateAZ
# 2
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number18642
License Number StateNV
# 3
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberDR.0073799
License Number StateCO
# 4
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number35.152420
License Number StateOH
# 5
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number4301513383
License Number StateMI
# 6
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberL9867
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: