Provider Demographics
NPI:1134194418
Name:LIVE HEALTHY MEDICAL ASSOCIATES, PA
Entity type:Organization
Organization Name:LIVE HEALTHY MEDICAL ASSOCIATES, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:INES
Authorized Official - Middle Name:E
Authorized Official - Last Name:VAZQUEZ
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:830-569-4660
Mailing Address - Street 1:1319 2ND ST
Mailing Address - Street 2:
Mailing Address - City:PLEASANTON
Mailing Address - State:TX
Mailing Address - Zip Code:78064-2213
Mailing Address - Country:US
Mailing Address - Phone:830-569-4660
Mailing Address - Fax:830-569-4760
Practice Address - Street 1:1319 2ND ST
Practice Address - Street 2:
Practice Address - City:PLEASANTON
Practice Address - State:TX
Practice Address - Zip Code:78064-2213
Practice Address - Country:US
Practice Address - Phone:830-569-4660
Practice Address - Fax:830-569-4760
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-02-21
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX00554YMedicare ID - Type Unspecified