MEDICARE: EVA CARRIZALES

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	208000000X	Pediatrics Physician	G4898	TX

General Provider Information

NPI Number	:	1134161649
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	EVA CARRIZALES

Provider Business Mailing Address
First Line	:	1140H W PIONEER PKWY
Second Line	:
City	:	ARLINGTON
State	:	TX
Zip	:	76013-6367
Country	:	US
Telephone Number	:	817-277-8419
Fax Number	:	817-226-3696

Provider Business Practice Location Address
First Line	:	1140H W PIONEER PKWY
Second Line	:
City	:	ARLINGTON
State	:	TX
Zip	:	76013-6367
Country	:	US
Telephone Number	:	817-277-8419
Fax Number	:	817-226-3696

Authorized Official
Title or Position	:	PHYSICIAN
Name	:	EVA CARRIZALES
Credential	:	D.O.
Telephone Number	:	817-277-9419

Provider Enumeration Date	:	06/11/2006
Last Update Date	:	08/22/2020

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