Healthcare Provider Details

I. General information

NPI: 1447558416
Provider Name (Legal Business Name): CARLOS ARMANDO MOTA M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/01/2011
Last Update Date: 08/30/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3851 ROGER BROOKE DR FORT SAM HOUSTON
SAN ANTONIO TX
78234-4501
US

IV. Provider business mailing address

3851 ROGER BROOKE DR FORT SAM HOUSTON
SAN ANTONIO TX
78234-4501
US

V. Phone/Fax

Practice location:
  • Phone: 787-568-5448
  • Fax:
Mailing address:
  • Phone: 787-568-5448
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License NumberQ8309
License Number StateTX
# 2
Primary TaxonomyN
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number27405
License Number StateNE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: