Provider Demographics
NPI:1740262013
Name:ABAYA, BERNARDINO FLORES (MD)
Entity type:Individual
Prefix:
First Name:BERNARDINO
Middle Name:FLORES
Last Name:ABAYA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 20149
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77225-0149
Mailing Address - Country:US
Mailing Address - Phone:713-383-7000
Mailing Address - Fax:713-383-7001
Practice Address - Street 1:2517 DORRINGTON ST
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77030-1928
Practice Address - Country:US
Practice Address - Phone:713-383-7000
Practice Address - Fax:713-383-7001
Is Sole Proprietor?:No
Enumeration Date:2005-11-14
Last Update Date:2017-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXJ2470207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX134161208Medicaid
TX1466689OtherMEDICAID OF LOUSIANA
TXP00064045OtherPALMETTO GBA RAILROAD
TX8AD670OtherBCBS #
TX8B1275Medicare PIN
TX1466689OtherMEDICAID OF LOUSIANA