Provider Demographics
NPI:1639699721
Name:TOVAR-TIENDA, ELEAZAR
Entity Type:Individual
Prefix:MR
First Name:ELEAZAR
Middle Name:
Last Name:TOVAR-TIENDA
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 1:2215 W MILE 6 1/2 RD
Mailing Address - Street 2:
Mailing Address - City:MISSION
Mailing Address - State:TX
Mailing Address - Zip Code:78574-0009
Mailing Address - Country:US
Mailing Address - Phone:956-638-3813
Mailing Address - Fax:956-584-2224
Practice Address - Street 1:2605 W MILE 5 RD
Practice Address - Street 2:
Practice Address - City:MISSION
Practice Address - State:TX
Practice Address - Zip Code:78574-0968
Practice Address - Country:US
Practice Address - Phone:956-638-3813
Practice Address - Fax:956-584-2224
Is Sole Proprietor?:No
Enumeration Date:2017-06-21
Last Update Date:2017-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246Z00000XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, Other
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX$$$$$$$$$Medicaid