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General NPI Number Information
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NPI Number | 1922716794
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Entity Type | Individual
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Provider Name | JEFERSON VASCONCELLOS MARADEI MD
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Gender | Male
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Dates
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Enumeration Date | 11/10/2022
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Last Update Date | 03/05/2023
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Provider Practice Location Address
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Address Line | 23103 IH 10 W STE 111
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City | SAN ANTONIO
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State | TX
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Zip | 78257-1766
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Country | US
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Telephone | 210-571-7546
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Fax |
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Provider Business Mailing Address
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Address Line | 413 UMAR AVE
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City | MCALLEN
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State | TX
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Zip | 78504-1972
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Country | US
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Telephone | 210-322-6792
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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 | 208200000X
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Taxonomy Name | Plastic Surgery Physician
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License Number | PENDING
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License Number State | TX
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Taxonomy #2
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Taxonomy Code | 2086S0122X
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Taxonomy Name | Plastic and Reconstructive Surgery Physician
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License Number | PENDING
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License Number State | TX
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