Provider Demographics
NPI: | 1831217298 |
---|---|
Name: | TEXIDOR, ALBERTO J (PHD) |
Entity type: | Individual |
Prefix: | DR |
First Name: | ALBERTO |
Middle Name: | J |
Last Name: | TEXIDOR |
Suffix: | |
Gender: | M |
Credentials: | PHD |
Other - Prefix: | |
Other - First Name: | |
Other - Middle Name: | |
Other - Last Name: | |
Other - Suffix: | |
Other - Last Name Type: | |
Other - Credentials: | |
Mailing Address - Street 1: | 2150 S DOBSON RD |
Mailing Address - Street 2: | SUITE 4 |
Mailing Address - City: | MESA |
Mailing Address - State: | AZ |
Mailing Address - Zip Code: | 85202-6487 |
Mailing Address - Country: | US |
Mailing Address - Phone: | 480-899-0238 |
Mailing Address - Fax: | 480-899-8135 |
Practice Address - Street 1: | 2150 S DOBSON RD |
Practice Address - Street 2: | SUITE 4 |
Practice Address - City: | MESA |
Practice Address - State: | AZ |
Practice Address - Zip Code: | 85202-6487 |
Practice Address - Country: | US |
Practice Address - Phone: | 480-899-0238 |
Practice Address - Fax: | 480-899-8135 |
Is Sole Proprietor?: | Yes |
Enumeration Date: | 2007-03-26 |
Last Update Date: | 2007-07-08 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Licenses
State | License ID | Taxonomies |
---|---|---|
AZ | 1169 | 103G00000X, 103TA0400X, 103TA0700X, 103TB0200X, 103TC1900X, 103TC2200X, 103TE1100X, 103TF0000X, 103TF0200X, 103TM1800X, 103T00000X, 103TR0400X, 103TS0200X |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization |
---|---|---|---|---|
Not Answered | 103G00000X | Behavioral Health & Social Service Providers | Clinical Neuropsychologist | |
Not Answered | 103TA0400X | Behavioral Health & Social Service Providers | Psychologist | Addiction (Substance Use Disorder) |
Not Answered | 103TA0700X | Behavioral Health & Social Service Providers | Psychologist | Adult Development & Aging |
Not Answered | 103TB0200X | Behavioral Health & Social Service Providers | Psychologist | Cognitive & Behavioral |
Not Answered | 103TC1900X | Behavioral Health & Social Service Providers | Psychologist | Counseling |
Not Answered | 103TC2200X | Behavioral Health & Social Service Providers | Psychologist | Clinical Child & Adolescent |
Not Answered | 103TE1100X | Behavioral Health & Social Service Providers | Psychologist | Exercise & Sports |
Not Answered | 103TF0000X | Behavioral Health & Social Service Providers | Psychologist | Family |
Not Answered | 103TF0200X | Behavioral Health & Social Service Providers | Psychologist | Forensic |
Not Answered | 103TM1800X | Behavioral Health & Social Service Providers | Psychologist | Intellectual & Developmental Disabilities |
Not Answered | 103T00000X | Behavioral Health & Social Service Providers | Psychologist | |
Not Answered | 103TR0400X | Behavioral Health & Social Service Providers | Psychologist | Rehabilitation |
Not Answered | 103TS0200X | Behavioral Health & Social Service Providers | Psychologist | School |
Provider Identifiers
State | Identifier ID | ID Type | Issuer |
---|---|---|---|
AZ | PHD1169 | Medicare ID - Type Unspecified |