Provider Demographics
NPI:1033146006
Name:AVALOS, SERGIO ANTONIO (MD)
Entity Type:Individual
Prefix:
First Name:SERGIO
Middle Name:ANTONIO
Last Name:AVALOS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:SERGIO
Other - Middle Name:ANTONIO
Other - Last Name:AVALOS
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:6101 BLUE LAGOON DR STE 400
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33126-2051
Mailing Address - Country:US
Mailing Address - Phone:305-500-2027
Mailing Address - Fax:305-500-2155
Practice Address - Street 1:917 S PORT AVE
Practice Address - Street 2:
Practice Address - City:CORPUS CHRISTI
Practice Address - State:TX
Practice Address - Zip Code:78405-2301
Practice Address - Country:US
Practice Address - Phone:361-882-3639
Practice Address - Fax:361-882-2650
Is Sole Proprietor?:No
Enumeration Date:2006-06-27
Last Update Date:2020-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXC7336207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1309478-01Medicaid
TXB21011Medicare UPIN