Provider Demographics
NPI:1033128772
Name:VICTORIA PEDIATRICS & ADOLESCENTS ASSOC.
Entity Type:Organization
Organization Name:VICTORIA PEDIATRICS & ADOLESCENTS ASSOC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:FELIX
Authorized Official - Middle Name:F
Authorized Official - Last Name:REGUEIRA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:361-576-2134
Mailing Address - Street 1:4304 RETAMA CIR
Mailing Address - Street 2:
Mailing Address - City:VICTORIA
Mailing Address - State:TX
Mailing Address - Zip Code:77901-2767
Mailing Address - Country:US
Mailing Address - Phone:361-576-2134
Mailing Address - Fax:361-578-0221
Practice Address - Street 1:4304 RETAMA CIR
Practice Address - Street 2:
Practice Address - City:VICTORIA
Practice Address - State:TX
Practice Address - Zip Code:77901-2767
Practice Address - Country:US
Practice Address - Phone:361-576-2134
Practice Address - Fax:361-578-0221
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-05
Last Update Date:2008-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXE9354261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX0059DJOtherBLUE CROSS BLUE SHIELD
TX092298101Medicaid
TX092298102Medicaid
TX4331614OtherAETNA
TX82920XOtherBLUE CROSS BLUE SHIELD
TX060378901Medicaid
TX060378901Medicaid