Healthcare Provider Details

I. General information

NPI: 1942206396
Provider Name (Legal Business Name): ALICIA VALERIUS TEZEL M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: ALICIA VALERIUS THOGMARTIN M.D.

II. Dates (important events)

Enumeration Date: 06/21/2005
Last Update Date: 03/22/2023
Certification Date: 03/22/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

24200 IH 10 W STE 108
SAN ANTONIO TX
78257-1150
US

IV. Provider business mailing address

14100 SAN PEDRO AVE STE 412
SAN ANTONIO TX
78232-2009
US

V. Phone/Fax

Practice location:
  • Phone: 210-263-9443
  • Fax:
Mailing address:
  • Phone: 210-281-8669
  • Fax: 210-314-5044

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2080P0006X
TaxonomyDevelopmental - Behavioral Pediatrics Physician
License NumberJ0309
License Number StateTX
# 2
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberJ0309
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: