Provider Demographics
NPI:1376839399
Name:FENANDO T. AVILA MD PA
Entity Type:Organization
Organization Name:FENANDO T. AVILA MD PA
Other - Org Name:THE PAIN MANAGEMENT CENTERS OF SOUTH TEXAS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CREDENTIALING
Authorized Official - Prefix:MRS
Authorized Official - First Name:CINDI
Authorized Official - Middle Name:
Authorized Official - Last Name:GARCIA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:713-532-9421
Mailing Address - Street 1:PO BOX 120040
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78212-9240
Mailing Address - Country:US
Mailing Address - Phone:210-223-1181
Mailing Address - Fax:210-226-1268
Practice Address - Street 1:700 S SAINT MARYS ST
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78205-3435
Practice Address - Country:US
Practice Address - Phone:210-223-1181
Practice Address - Fax:210-226-1268
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-06-28
Last Update Date:2011-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXG2899207LP2900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain MedicineGroup - Single Specialty