Provider Demographics
NPI:1457791618
Name:ATENCIO, ANNA (DO)
Entity Type:Individual
Prefix:
First Name:ANNA
Middle Name:
Last Name:ATENCIO
Suffix:
Gender:F
Credentials:DO
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:PO BOX 3046
Mailing Address - Street 2:
Mailing Address - City:MALVERN
Mailing Address - State:PA
Mailing Address - Zip Code:19355-0746
Mailing Address - Country:US
Mailing Address - Phone:956-424-7655
Mailing Address - Fax:956-424-7049
Practice Address - Street 1:306 E MAIN AVE
Practice Address - Street 2:SUITE 5 & 6
Practice Address - City:ALTON
Practice Address - State:TX
Practice Address - Zip Code:78573-6955
Practice Address - Country:US
Practice Address - Phone:956-424-7655
Practice Address - Fax:956-424-7049
Is Sole Proprietor?:No
Enumeration Date:2013-07-02
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
IL125062559207Q00000X
TXQ9781207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX3630808-01Medicaid