Provider Demographics
NPI:1851317432
Name:AMADOR, MARIANO (MD)
Entity Type:Individual
Prefix:DR
First Name:MARIANO
Middle Name:
Last Name:AMADOR
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4646 RIVERSTONE BLVD.
Mailing Address - Street 2:
Mailing Address - City:MISSOURI CITY
Mailing Address - State:TX
Mailing Address - Zip Code:77459-6141
Mailing Address - Country:US
Mailing Address - Phone:281-499-1855
Mailing Address - Fax:281-499-1585
Practice Address - Street 1:4646 RIVERSTONE BLVD.
Practice Address - Street 2:
Practice Address - City:MISSOURI CITY
Practice Address - State:TX
Practice Address - Zip Code:77459-6141
Practice Address - Country:US
Practice Address - Phone:281-499-1855
Practice Address - Fax:281-499-1585
Is Sole Proprietor?:No
Enumeration Date:2006-07-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXK0603208000000X
OR19837208000000X
WA31628208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
G77453Medicare UPIN