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General NPI Number Information
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NPI Number | 1356552004
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Entity Type | Organization
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Legal Business Name | AFFILIATES IN DIGESTIVE & LIVER DISEASES, P.A.
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Dates
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Enumeration Date | 05/24/2007
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Last Update Date | 06/15/2015
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Provider Practice Location Address
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Address Line | 5508 OCEAN DR
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City | CORPUS CHRISTI
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State | TX
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Zip | 78412-2750
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Country | US
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Telephone | 361-215-3285
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Fax | 361-906-0125
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Provider Business Mailing Address
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Address Line | 5508 OCEAN DR
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City | CORPUS CHRISTI
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State | TX
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Zip | 78412-2750
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Country | US
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Telephone | 361-215-3285
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Fax | 361-906-0125
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Authorized Official
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Title or Position | CEO
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Name | DR. MANUEL MIRELES PEREZ
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Credential | M.D.
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Telephone | 361-215-3285
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number | F7877
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License Number State | TX
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