Healthcare Provider Details

I. General information

NPI: 1205947710
Provider Name (Legal Business Name): AUSTIN INFECTIOUS DISEASE CONSULTANTS, PA 080191
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/31/2006
Last Update Date: 12/09/2021
Certification Date: 12/09/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1301 W 38TH ST STE 403
AUSTIN TX
78705-1013
US

IV. Provider business mailing address

1301 W 38TH ST STE 403
AUSTIN TX
78705-1000
US

V. Phone/Fax

Practice location:
  • Phone: 512-459-0301
  • Fax: 512-459-9701
Mailing address:
  • Phone: 512-459-0301
  • Fax: 512-459-9701

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RI0200X
TaxonomyInfectious Disease Physician
License Number
License Number State

VIII. Authorized Official

Name: ARIANA MARES
Title or Position: PRACTICE MANAGER
Credential: CMM
Phone: 512-593-7902