MEDICARE: DR. ALICIA VALERIUS TEZEL 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	2080P0006X	Developmental - Behavioral Pediatrics Physician	J0309	TX
2	208000000X	Pediatrics Physician	J0309	TX

General Provider Information

NPI Number	:	1942206396
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ALICIA VALERIUS TEZEL M.D.

Provider Business Mailing Address
First Line	:	14100 SAN PEDRO AVE STE 412
Second Line	:
City	:	SAN ANTONIO
State	:	TX
Zip	:	78232-2009
Country	:	US
Telephone Number	:	210-281-8669
Fax Number	:	210-314-5044

Provider Business Practice Location Address
First Line	:	24200 IH 10 W STE 108
Second Line	:
City	:	SAN ANTONIO
State	:	TX
Zip	:	78257-1150
Country	:	US
Telephone Number	:	210-263-9443
Fax Number	:

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

Provider Enumeration Date	:	06/21/2005
Last Update Date	:	03/22/2023

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