Provider Demographics
NPI:1518318252
Name:LONGORIA-DUBOCQ, TEXELL XAVIER
Entity Type:Individual
Prefix:
First Name:TEXELL
Middle Name:XAVIER
Last Name:LONGORIA-DUBOCQ
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:D9 CALLE CORSEGA
Mailing Address - Street 2:PARQUE MEDITERRANEO
Mailing Address - City:GUAYNABO
Mailing Address - State:PR
Mailing Address - Zip Code:00966
Mailing Address - Country:US
Mailing Address - Phone:787-466-9603
Mailing Address - Fax:
Practice Address - Street 1:D9 CALLE CORSEGA
Practice Address - Street 2:PARQUE MEDITERRANEO
Practice Address - City:GUAYNABO
Practice Address - State:PR
Practice Address - Zip Code:00966
Practice Address - Country:US
Practice Address - Phone:787-466-9603
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-06-23
Last Update Date:2024-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR23717208600000X
NY323398-01208600000X
PR34371R208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery