Provider Demographics
NPI:1801925755
Name:OAFERINA PROFESSIONAL CORP.
Entity type:Organization
Organization Name:OAFERINA PROFESSIONAL CORP.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:ALETH
Authorized Official - Middle Name:
Authorized Official - Last Name:OAFERINA
Authorized Official - Suffix:SR
Authorized Official - Credentials:PT
Authorized Official - Phone:956-791-8235
Mailing Address - Street 1:PO BOX 451267
Mailing Address - Street 2:
Mailing Address - City:LAREDO
Mailing Address - State:TX
Mailing Address - Zip Code:78045-0031
Mailing Address - Country:US
Mailing Address - Phone:956-791-8235
Mailing Address - Fax:956-791-8239
Practice Address - Street 1:414 SHILOH DR UNIT 9
Practice Address - Street 2:
Practice Address - City:LAREDO
Practice Address - State:TX
Practice Address - Zip Code:78045-6745
Practice Address - Country:US
Practice Address - Phone:956-791-8235
Practice Address - Fax:956-791-8239
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-05
Last Update Date:2010-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX108458225X00000X
TX1076438225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty
No225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX174055701Medicaid
TXP00093028Medicare PIN
TX00374XMedicare PIN