Provider Demographics
NPI:1578583001
Name:ANDAYA, ALFREDO R (MD)
Entity Type:Individual
Prefix:DR
First Name:ALFREDO
Middle Name:R
Last Name:ANDAYA
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:1311 GENERAL CAVAZOS BLVD
Mailing Address - Street 2:SUITE 301
Mailing Address - City:KINGSVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:78363-7129
Mailing Address - Country:US
Mailing Address - Phone:361-595-5526
Mailing Address - Fax:361-595-1050
Practice Address - Street 1:1311 GENERAL CAVAZOS BLVD
Practice Address - Street 2:SUITE 301
Practice Address - City:KINGSVILLE
Practice Address - State:TX
Practice Address - Zip Code:78363
Practice Address - Country:US
Practice Address - Phone:361-595-5526
Practice Address - Fax:361-595-1050
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-20
Last Update Date:2018-08-23
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Provider Licenses
StateLicense IDTaxonomies
TXJ4694208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX742085274OtherTAXPAYER IDENTIFICATION
TX126915106Medicaid
TX126915102Medicaid
TX126915102Medicaid