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NPI Code Detail

MEDICARE: ANA M AVALOS MISHAAN MD

MEDICARE: ANA M AVALOS MISHAAN MD
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
1208000000XPediatrics PhysicianN0616TX

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1137345810OTHERTXCSHCN GROUP
2MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3197453702OTHERTXCSHCN
4MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
51750369203OTHERGROUP NPI
6MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1528099058
Entity Type Code : Individual
Provider Name (Legal Business Name) : ANA M AVALOS MISHAAN MD
Provider Business Mailing Address
First Line : 825 E RUNDBERG LN STE B1
Second Line :
City : AUSTIN
State : TX
Zip : 78753-4860
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 825 E RUNDBERG LN STE B1
Second Line :
City : AUSTIN
State : TX
Zip : 78753-4860
Country : US
Telephone Number : 512-978-9600
Fax Number : 512-978-9601
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/05/2006
Last Update Date : 10/02/2017

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Directions to “ ANA M AVALOS MISHAAN MD” Practice Location

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