Healthcare Provider Details

I. General information

NPI: 1528085206
Provider Name (Legal Business Name): EAR, NOSE & THROAT ASSOCIATES OF CORPUS CHRISTI
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/17/2006
Last Update Date: 03/06/2023
Certification Date: 03/06/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5959 S STAPLES ST STE 102
CORPUS CHRISTI TX
78413-3844
US

IV. Provider business mailing address

5959 S STAPLES ST STE 102
CORPUS CHRISTI TX
78413-3844
US

V. Phone/Fax

Practice location:
  • Phone: 361-854-7000
  • Fax: 361-814-2685
Mailing address:
  • Phone: 361-854-7000
  • Fax: 361-814-2685

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Y00000X
TaxonomyOtolaryngology Physician
License Number0080251703
License Number StateTX

VIII. Authorized Official

Name: MS. SYLVIA GONZALES
Title or Position: BUSINESS OFFICE MANAGER
Credential:
Phone: 361-854-7000