Healthcare Provider Details

I. General information

NPI: 1588325047
Provider Name (Legal Business Name): MARIANA ARACELY FLORES PIMENTEL
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/06/2022
Last Update Date: 06/27/2024
Certification Date: 06/27/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8611 N MOPAC EXPY STE 300
AUSTIN TX
78759-8319
US

IV. Provider business mailing address

8611 N MOPAC EXPY STE 300
AUSTIN TX
78759-8319
US

V. Phone/Fax

Practice location:
  • Phone: 737-220-8200
  • Fax: 737-220-8180
Mailing address:
  • Phone: 737-220-8200
  • Fax: 737-220-8180

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207WX0110X
TaxonomyPediatric Ophthalmology and Strabismus Specialist Physician Physician
License Number70336
License Number StateCT
# 2
Primary TaxonomyN
Taxonomy Code207WX0110X
TaxonomyPediatric Ophthalmology and Strabismus Specialist Physician Physician
License Number8608704
License Number StateZZ
# 3
Primary TaxonomyY
Taxonomy Code207WX0110X
TaxonomyPediatric Ophthalmology and Strabismus Specialist Physician Physician
License Number48286
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: