Healthcare Provider Details

I. General information

NPI: 1154669158
Provider Name (Legal Business Name): FELIPE M AVILA MD PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/25/2013
Last Update Date: 01/25/2013
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:
Mailing address:
  • Phone: 956-968-0103
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number
License Number State

VIII. Authorized Official

Name: FELIPE AVILA
Title or Position: OWNER
Credential:
Phone: 956-968-0103