Provider Demographics
NPI:1346646510
Name:ARISMENDEZ, MATTHEW (PA-C)
Entity Type:Individual
Prefix:
First Name:MATTHEW
Middle Name:
Last Name:ARISMENDEZ
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7323 MARBACH RD STE 104
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78227-1905
Mailing Address - Country:US
Mailing Address - Phone:210-674-0257
Mailing Address - Fax:210-674-0257
Practice Address - Street 1:7323 MARBACH RD STE 104
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78227-1905
Practice Address - Country:US
Practice Address - Phone:210-674-0257
Practice Address - Fax:210-369-9064
Is Sole Proprietor?:No
Enumeration Date:2014-11-14
Last Update Date:2024-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXPA09452363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1508813494OtherGROUP NPI#
TXPA09452OtherPHYSICIAN ASSISTANT LICENSE #
TX00295NOtherMEDICARE GRP#
TX1346646510OtherINDIVIDUAL NPI#
TX0925166-01OtherTRADITIONAL MEDICAID GRP#
TX00295NOtherMEDICARE GRP#
TX5698099208OtherPECOS ID#