MEDICARE: DR. AVELINA SANTOS DIMAANDAL 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	E3896	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	T991	OTHER	TX	BLUE CROSS BLUE SHIELD

General Provider Information

NPI Number	:	1982663845
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. AVELINA SANTOS DIMAANDAL MD

Provider Business Mailing Address
First Line	:	609 9TH AVE N
Second Line	:
City	:	TEXAS CITY
State	:	TX
Zip	:	77590
Country	:	US
Telephone Number	:	409-948-3148
Fax Number	:	409-948-6602

Provider Business Practice Location Address
First Line	:	609 9TH AVE N
Second Line	:
City	:	TEXAS CITY
State	:	TX
Zip	:	77590
Country	:	US
Telephone Number	:	409-948-3148
Fax Number	:	409-948-6602

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

Provider Enumeration Date	:	03/20/2006
Last Update Date	:	02/15/2026

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