Provider Demographics
NPI:1083100614
Name:TABORDA ALVAREZ, MARVIC MARIA
Entity Type:Individual
Prefix:
First Name:MARVIC
Middle Name:MARIA
Last Name:TABORDA ALVAREZ
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1470
Mailing Address - Street 2:
Mailing Address - City:EAGLE PASS
Mailing Address - State:TX
Mailing Address - Zip Code:78853-1470
Mailing Address - Country:US
Mailing Address - Phone:830-773-8917
Mailing Address - Fax:830-773-1892
Practice Address - Street 1:4018 EL INDIO HWY
Practice Address - Street 2:
Practice Address - City:EAGLE PASS
Practice Address - State:TX
Practice Address - Zip Code:78852-6690
Practice Address - Country:US
Practice Address - Phone:830-872-3460
Practice Address - Fax:830-872-3470
Is Sole Proprietor?:No
Enumeration Date:2018-07-06
Last Update Date:2023-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXS9805208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY1346380870Medicaid
TX4302259-01Medicaid