Healthcare Provider Details

I. General information

NPI: 1194764225
Provider Name (Legal Business Name): FELIPE MIGUEL AVILA M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/05/2006
Last Update Date: 05/22/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1408 E 8TH ST
WESLACO TX
78596-6639
US

IV. Provider business mailing address

1408 E 8TH ST
WESLACO TX
78596-6639
US

V. Phone/Fax

Practice location:
  • Phone: 956-968-0103
  • Fax: 956-968-0481
Mailing address:
  • Phone: 956-968-0103
  • Fax: 956-968-0481

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberL1521
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: