Healthcare Provider Details

I. General information

NPI: 1689879009
Provider Name (Legal Business Name): WILLIBALDO OJEDA M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/16/2007
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

102 N MAGDALEN ST
SAN ANGELO TX
76903-5400
US

IV. Provider business mailing address

PO BOX 22000
SAN ANGELO TX
76902-7200
US

V. Phone/Fax

Practice location:
  • Phone: 325-658-1511
  • Fax: 325-481-2166
Mailing address:
  • Phone: 325-658-1511
  • Fax: 325-481-2166

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number15475
License Number StatePR
# 2
Primary TaxonomyN
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number15475
License Number StatePR
# 3
Primary TaxonomyY
Taxonomy Code207RC0001X
TaxonomyClinical Cardiac Electrophysiology Physician
License Number15475
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: