Provider Demographics
NPI:1750646675
Name:DAVID A. MAYORGA, M.D.,P.A.
Entity Type:Organization
Organization Name:DAVID A. MAYORGA, M.D.,P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:ALVARO
Authorized Official - Last Name:MAYORGA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:956-424-3052
Mailing Address - Street 1:3201 SAN CLEMENTE
Mailing Address - Street 2:
Mailing Address - City:MISSION
Mailing Address - State:TX
Mailing Address - Zip Code:78572-7682
Mailing Address - Country:US
Mailing Address - Phone:956-424-3052
Mailing Address - Fax:956-424-3219
Practice Address - Street 1:1022 E GRIFFIN PKWY STE 201
Practice Address - Street 2:
Practice Address - City:MISSION
Practice Address - State:TX
Practice Address - Zip Code:78572-2402
Practice Address - Country:US
Practice Address - Phone:956-424-3052
Practice Address - Fax:956-424-3219
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-07-06
Last Update Date:2012-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXL8428207RI0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RI0200XAllopathic & Osteopathic PhysiciansInternal MedicineInfectious DiseaseGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX162581602Medicaid
TX8V4021OtherBLUE CROSS
TX8V4021OtherBLUE CROSS
TXH50134Medicare UPIN