MEDICARE: VICTORIA PEDIATRICS & ADOLESCENTS ASSOC.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QP2300X	Primary Care Clinic/Center	E9354	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	0059DJ	OTHER	TX	BLUE CROSS BLUE SHIELD
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
4	4331614	OTHER	TX	AETNA
5	82920X	OTHER	TX	BLUE CROSS BLUE SHIELD
6	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1033128772
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	VICTORIA PEDIATRICS & ADOLESCENTS ASSOC.

Provider Business Mailing Address
First Line	:	4304 RETAMA CIR
Second Line	:
City	:	VICTORIA
State	:	TX
Zip	:	77901-2767
Country	:	US
Telephone Number	:	361-576-2134
Fax Number	:	361-578-0221

Provider Business Practice Location Address
First Line	:	4304 RETAMA CIR
Second Line	:
City	:	VICTORIA
State	:	TX
Zip	:	77901-2767
Country	:	US
Telephone Number	:	361-576-2134
Fax Number	:	361-578-0221

Authorized Official
Title or Position	:	PRESIDENT
Name	:	FELIX F REGUEIRA
Credential	:
Telephone Number	:	361-576-2134

Provider Enumeration Date	:	08/05/2006
Last Update Date	:	06/24/2008

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Directions to “VICTORIA PEDIATRICS & ADOLESCENTS ASSOC. ” Practice Location

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