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General NPI Number Information
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NPI Number | 1639631773
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Entity Type | Individual
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Provider Name | ANTONIO AURELIO FAZ MD, MPH
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Gender | Male
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Dates
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Enumeration Date | 04/05/2019
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Last Update Date | 10/15/2024
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Provider Practice Location Address
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Address Line | 4602 N BARTLETT AVE
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City | LAREDO
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State | TX
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Zip | 78041-3803
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Country | US
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Telephone | 956-523-7850
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Fax |
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Provider Business Mailing Address
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Address Line | 1700 E SAUNDERS ST
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City | LAREDO
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State | TX
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Zip | 78041-5474
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Country | US
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Telephone | 956-796-5000
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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 | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | ME164963
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License Number State | FL
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