Provider Demographics
NPI:1659768166
Name:SRIVASTAVA, ANURAG
Entity Type:Individual
Prefix:
First Name:ANURAG
Middle Name:
Last Name:SRIVASTAVA
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:PO BOX 720732
Mailing Address - Street 2:
Mailing Address - City:MCALLEN
Mailing Address - State:TX
Mailing Address - Zip Code:78504-0732
Mailing Address - Country:US
Mailing Address - Phone:956-533-6049
Mailing Address - Fax:
Practice Address - Street 1:3001 N MCCOLL ST
Practice Address - Street 2:
Practice Address - City:HIDALGO
Practice Address - State:TX
Practice Address - Zip Code:78557-3935
Practice Address - Country:US
Practice Address - Phone:956-533-6049
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-04-22
Last Update Date:2019-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAP127078363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX348362005Medicaid
TX348362006Medicaid
TX8304MCOtherBCBS
TX424535ZXN4OtherMEDICARE
TXP0178748OtherRAILROAD MEDICARE