Provider Demographics
NPI:1851726780
Name:URESTI, AMANDO ALBERTO (PA)
Entity Type:Individual
Prefix:
First Name:AMANDO
Middle Name:ALBERTO
Last Name:URESTI
Suffix:
Gender:M
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:2952 BOCA CHICA BLVD
Mailing Address - Street 2:
Mailing Address - City:BROWNSVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:78521-3506
Mailing Address - Country:US
Mailing Address - Phone:956-243-8888
Mailing Address - Fax:956-243-8889
Practice Address - Street 1:2952 BOCA CHICA BLVD
Practice Address - Street 2:
Practice Address - City:BROWNSVILLE
Practice Address - State:TX
Practice Address - Zip Code:78521
Practice Address - Country:US
Practice Address - Phone:956-243-8888
Practice Address - Fax:956-243-8889
Is Sole Proprietor?:No
Enumeration Date:2013-09-11
Last Update Date:2014-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXPA08473363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant