Healthcare Provider Details

I. General information

NPI: 1033128772
Provider Name (Legal Business Name): VICTORIA PEDIATRICS & ADOLESCENTS ASSOC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/05/2006
Last Update Date: 06/24/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4304 RETAMA CIR
VICTORIA TX
77901-2767
US

IV. Provider business mailing address

4304 RETAMA CIR
VICTORIA TX
77901-2767
US

V. Phone/Fax

Practice location:
  • Phone: 361-576-2134
  • Fax: 361-578-0221
Mailing address:
  • Phone: 361-576-2134
  • Fax: 361-578-0221

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QP2300X
TaxonomyPrimary Care Clinic/Center
License NumberE9354
License Number StateTX

VIII. Authorized Official

Name: FELIX F REGUEIRA
Title or Position: PRESIDENT
Credential:
Phone: 361-576-2134