Provider Demographics
NPI:1922025998
Name:JOSE L BERLIOZ MD PA
Entity Type:Organization
Organization Name:JOSE L BERLIOZ MD PA
Other - Org Name:SAFARI PEDIATRICS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:GENERAL MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:MARY
Authorized Official - Middle Name:
Authorized Official - Last Name:KAFATI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:956-763-6335
Mailing Address - Street 1:PO BOX 450594
Mailing Address - Street 2:
Mailing Address - City:LAREDO
Mailing Address - State:TX
Mailing Address - Zip Code:78045-0014
Mailing Address - Country:US
Mailing Address - Phone:956-724-7145
Mailing Address - Fax:956-724-4865
Practice Address - Street 1:10710 MCPHERSON RD STE 101
Practice Address - Street 2:
Practice Address - City:LAREDO
Practice Address - State:TX
Practice Address - Zip Code:78045-6363
Practice Address - Country:US
Practice Address - Phone:956-724-7145
Practice Address - Fax:956-724-4944
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-16
Last Update Date:2023-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2080N0001XAllopathic & Osteopathic PhysiciansPediatricsNeonatal-Perinatal MedicineGroup - Multi-Specialty
No208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Multi-Specialty
No2080P0203XAllopathic & Osteopathic PhysiciansPediatricsPediatric Critical Care MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX0036GWOtherBCBS
TX144557903Medicaid
TX144557902Medicaid
TX144557901Medicaid
TX144557901Medicaid