Healthcare Provider Details

I. General information

NPI: 1760011969
Provider Name (Legal Business Name): JAVIER ARMENTA PA-C
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/08/2020
Last Update Date: 08/15/2023
Certification Date: 08/15/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3200 RED RIVER ST STE 201
AUSTIN TX
78705-2655
US

IV. Provider business mailing address

313 E 12TH ST STE 101
AUSTIN TX
78701-1955
US

V. Phone/Fax

Practice location:
  • Phone: 855-481-8375
  • Fax:
Mailing address:
  • Phone: 512-324-9650
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA13500
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: