MEDICARE: DR. JOSE L BERLIOZ 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
1	208000000X	Pediatrics Physician	K5812	TX
2	2080P0203X	Pediatric Critical Care Medicine Physician	K5812	TX
3	2080N0001X	Neonatal-Perinatal Medicine Physician	K5812	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
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1578599205
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JOSE L BERLIOZ MD

Provider Business Mailing Address
First Line	:	P O BOX 450594
Second Line	:
City	:	LAREDO
State	:	TX
Zip	:	78045-0014
Country	:	US
Telephone Number	:	956-724-7145
Fax Number	:	956-724-4944

Provider Business Practice Location Address
First Line	:	10710 MCPHERSON RD STE 101
Second Line	:
City	:	LAREDO
State	:	TX
Zip	:	78045-6363
Country	:	US
Telephone Number	:	956-724-7145
Fax Number	:	956-724-4944

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

Provider Enumeration Date	:	06/24/2006
Last Update Date	:	10/24/2023

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Directions to “ DR. JOSE L BERLIOZ MD” Practice Location

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