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General NPI Number Information
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NPI Number | 1316738354
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Entity Type | Individual
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Provider Name | ANTONIO TEIXEIRA PA-C
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Gender | Male
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Dates
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Enumeration Date | 05/16/2025
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Last Update Date | 11/13/2025
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Provider Practice Location Address
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Address Line | 114 WOODLAND ST
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City | HARTFORD
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State | CT
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Zip | 06105-1208
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Country | US
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Telephone | 860-714-4000
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Fax |
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Provider Business Mailing Address
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Address Line | 74 GERTRUDE AVE
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City | WATERBURY
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State | CT
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Zip | 06708-1740
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | 7147
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License Number State | CT
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Taxonomy #2
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Taxonomy Code | 363AM0700X
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Taxonomy Name | Medical Physician Assistant
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License Number | 7147
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License Number State | CT
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