Provider Demographics
NPI:1558771642
Name:ARMENDARIZ, AUBRY E (PA-C)
Entity Type:Individual
Prefix:MS
First Name:AUBRY
Middle Name:E
Last Name:ARMENDARIZ
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2260 TRAWOOD DR
Mailing Address - Street 2:
Mailing Address - City:EL PASO
Mailing Address - State:TX
Mailing Address - Zip Code:79935-3040
Mailing Address - Country:US
Mailing Address - Phone:915-591-4632
Mailing Address - Fax:915-591-4069
Practice Address - Street 1:2260 TRAWOOD DR
Practice Address - Street 2:
Practice Address - City:EL PASO
Practice Address - State:TX
Practice Address - Zip Code:79935-3040
Practice Address - Country:US
Practice Address - Phone:915-591-4632
Practice Address - Fax:915-591-4069
Is Sole Proprietor?:No
Enumeration Date:2014-04-29
Last Update Date:2016-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXPA08887363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX353809201Medicaid
TX468687YLPSOtherWELLMED PTAN