Provider Demographics
NPI:1205926094
Name:WIERNIK, PAOLA DEBORAH (MD)
Entity type:Individual
Prefix:DR
First Name:PAOLA
Middle Name:DEBORAH
Last Name:WIERNIK
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4412 N MCCOLL RD
Mailing Address - Street 2:
Mailing Address - City:MCALLEN
Mailing Address - State:TX
Mailing Address - Zip Code:78504-2480
Mailing Address - Country:US
Mailing Address - Phone:956-668-0700
Mailing Address - Fax:956-668-0710
Practice Address - Street 1:4412 N MCCOLL RD
Practice Address - Street 2:
Practice Address - City:MCALLEN
Practice Address - State:TX
Practice Address - Zip Code:78504-2480
Practice Address - Country:US
Practice Address - Phone:956-668-0700
Practice Address - Fax:956-668-0710
Is Sole Proprietor?:No
Enumeration Date:2006-10-13
Last Update Date:2014-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXK3878208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX154890101Medicaid
TX154890102Medicaid
TX154890104Medicaid
TX1790005585OtherNPI GROUP
TX154890105Medicaid