Provider Demographics
NPI:1003121245
Name:AYESTARAN CASSANI, ALEJANDRA C (MD)
Entity Type:Individual
Prefix:
First Name:ALEJANDRA
Middle Name:C
Last Name:AYESTARAN CASSANI
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2141 HAMILTON WAY
Mailing Address - Street 2:STE 100
Mailing Address - City:SAN ANGELO
Mailing Address - State:TX
Mailing Address - Zip Code:76904-6831
Mailing Address - Country:US
Mailing Address - Phone:325-245-4301
Mailing Address - Fax:325-245-4034
Practice Address - Street 1:2141 HAMILTON WAY
Practice Address - Street 2:STE 100
Practice Address - City:SAN ANGELO
Practice Address - State:TX
Practice Address - Zip Code:76904-6831
Practice Address - Country:US
Practice Address - Phone:325-245-4301
Practice Address - Fax:325-245-4034
Is Sole Proprietor?:No
Enumeration Date:2010-08-12
Last Update Date:2011-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXN7213208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX283015001Medicaid
TXTXB111678Medicare PIN