Provider Demographics
NPI:1356640916
Name:PETTLE, LUZ OLAYA (MD)
Entity Type:Individual
Prefix:DR
First Name:LUZ
Middle Name:OLAYA
Last Name:PETTLE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:LUZ
Other - Middle Name:OLAYA
Other - Last Name:AVILEZ
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:PO BOX 3046
Mailing Address - Street 2:
Mailing Address - City:MALVERN
Mailing Address - State:PA
Mailing Address - Zip Code:19355-0746
Mailing Address - Country:US
Mailing Address - Phone:956-992-0730
Mailing Address - Fax:956-992-8862
Practice Address - Street 1:1800 S 5TH ST
Practice Address - Street 2:
Practice Address - City:MCALLEN
Practice Address - State:TX
Practice Address - Zip Code:78503-2909
Practice Address - Country:US
Practice Address - Phone:956-992-0730
Practice Address - Fax:956-992-8862
Is Sole Proprietor?:No
Enumeration Date:2011-03-22
Last Update Date:2018-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXR6076207V00000X, 207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX387007301Medicaid