Provider Demographics
NPI:1457317232
Name:ARIZMENDI, ALEJANDRO (MD)
Entity Type:Individual
Prefix:
First Name:ALEJANDRO
Middle Name:
Last Name:ARIZMENDI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12002 BANDERA RD
Mailing Address - Street 2:111
Mailing Address - City:HELOTES
Mailing Address - State:TX
Mailing Address - Zip Code:78023-4668
Mailing Address - Country:US
Mailing Address - Phone:210-695-9002
Mailing Address - Fax:
Practice Address - Street 1:12002 BANDERA RD
Practice Address - Street 2:111
Practice Address - City:HELOTES
Practice Address - State:TX
Practice Address - Zip Code:78023-4668
Practice Address - Country:US
Practice Address - Phone:210-695-9002
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-21
Last Update Date:2013-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01058184A207R00000X
TXM7015207RG0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0300XAllopathic & Osteopathic PhysiciansInternal MedicineGeriatric Medicine
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200104370Medicaid
IN715530Z9Medicare ID - Type Unspecified
IN200104370Medicaid
TX275655YP9WMedicare PIN