Provider Demographics
NPI:1114331063
Name:ALICEA, CARLOS (MD)
Entity Type:Individual
Prefix:
First Name:CARLOS
Middle Name:
Last Name:ALICEA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:CARLOS
Other - Middle Name:
Other - Last Name:ALICEA ROSADO
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:1901 S 24TH AVE
Mailing Address - Street 2:
Mailing Address - City:EDINBURG
Mailing Address - State:TX
Mailing Address - Zip Code:78539-6533
Mailing Address - Country:US
Mailing Address - Phone:956-289-7000
Mailing Address - Fax:956-289-7257
Practice Address - Street 1:2215 W BUSINESS 83
Practice Address - Street 2:
Practice Address - City:WESLACO
Practice Address - State:TX
Practice Address - Zip Code:78596-1100
Practice Address - Country:US
Practice Address - Phone:956-520-8800
Practice Address - Fax:956-513-0355
Is Sole Proprietor?:No
Enumeration Date:2014-06-19
Last Update Date:2023-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXR99072084P0800X, 2084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Single Specialty