Provider Demographics
NPI:1467436014
Name:NATIVIDAD, ALEJANDRO V (MD)
Entity Type:Individual
Prefix:DR
First Name:ALEJANDRO
Middle Name:V
Last Name:NATIVIDAD
Suffix:
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:ALEX
Other - Middle Name:V
Other - Last Name:NATIVIDAD
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:1731 HAGY BLVD
Mailing Address - Street 2:
Mailing Address - City:AMARILLO
Mailing Address - State:TX
Mailing Address - Zip Code:79106-1710
Mailing Address - Country:US
Mailing Address - Phone:806-352-2742
Mailing Address - Fax:806-352-2744
Practice Address - Street 1:1731 HAGY BLVD
Practice Address - Street 2:
Practice Address - City:AMARILLO
Practice Address - State:TX
Practice Address - Zip Code:79106-1710
Practice Address - Country:US
Practice Address - Phone:806-352-2742
Practice Address - Fax:806-352-2744
Is Sole Proprietor?:Yes
Enumeration Date:2005-12-06
Last Update Date:2008-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXJ61902084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX00N05HMedicare ID - Type Unspecified
TX853165Medicare PIN
TXF28123Medicare UPIN