MEDICARE: SERGIO ANTONIO AVALOS M.D.

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	207Q00000X	Family Medicine Physician	C7336	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1033146006
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SERGIO ANTONIO AVALOS M.D.

Provider Business Mailing Address
First Line	:	6101 BLUE LAGOON DR STE 400
Second Line	:
City	:	MIAMI
State	:	FL
Zip	:	33126-2051
Country	:	US
Telephone Number	:	305-500-2027
Fax Number	:	305-500-2155

Provider Business Practice Location Address
First Line	:	917 S PORT AVE
Second Line	:
City	:	CORPUS CHRISTI
State	:	TX
Zip	:	78405-2301
Country	:	US
Telephone Number	:	361-882-3639
Fax Number	:	361-882-2650

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/27/2006
Last Update Date	:	09/22/2020

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