Provider Demographics
NPI:1518968395
Name:VITERI, ALFREDO LUIS (MD)
Entity Type:Individual
Prefix:DR
First Name:ALFREDO
Middle Name:LUIS
Last Name:VITERI
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 1:902 FROSTWOOD DR
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77024-2403
Mailing Address - Country:US
Mailing Address - Phone:713-984-2770
Mailing Address - Fax:173-932-1403
Practice Address - Street 1:902 FROSTWOOD DR
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77024-2403
Practice Address - Country:US
Practice Address - Phone:713-984-2770
Practice Address - Fax:173-932-1403
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-03
Last Update Date:2013-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXD7799174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX035735201Medicaid
TX8B4830OtherBC/BS
TX8B4830OtherBC/BS
TXB27357Medicare UPIN