MEDICARE: DR. VENTZISLAV D VANGUELOV 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	207V00000X	Obstetrics & Gynecology Physician	L9946	TX

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	TXB133201	OTHER	TX	MEDICARE

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	:	1457359333
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. VENTZISLAV D VANGUELOV M.D.

Provider Business Mailing Address
First Line	:	PO BOX 1689
Second Line	:
City	:	PHARR
State	:	TX
Zip	:	78577-1630
Country	:	US
Telephone Number	:	956-787-0787
Fax Number	:	956-787-2021

Provider Business Practice Location Address
First Line	:	806 W 3RD ST
Second Line	:
City	:	SAN JUAN
State	:	TX
Zip	:	78589
Country	:	US
Telephone Number	:	956-787-0787
Fax Number	:

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

Provider Enumeration Date	:	07/13/2005
Last Update Date	:	08/31/2018

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Directions to “ DR. VENTZISLAV D VANGUELOV M.D.” Practice Location

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