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NPI Code Detail

MEDICARE: MR. SERGIO VALLEJO PA-C

MEDICARE: MR. SERGIO VALLEJO PA-C
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
1363A00000XPhysician AssistantPA10579TX

General Provider Information

NPI Number : 1932559622
Entity Type Code : Individual
Provider Name (Legal Business Name) : MR. SERGIO VALLEJO PA-C
Provider Business Mailing Address
First Line : 4013 DOGWOOD LN
Second Line :
City : FORT WORTH
State : TX
Zip : 76137-1715
Country : US
Telephone Number : 562-519-2254
Fax Number :
Provider Business Practice Location Address
First Line : 900 8TH AVE
Second Line :
City : FORT WORTH
State : TX
Zip : 76104-3902
Country : US
Telephone Number : 817-877-5292
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/14/2016
Last Update Date : 12/03/2025

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