Provider Demographics
NPI:1841324340
Name:ANTONIETA A GIMOTEA MD PA
Entity type:Organization
Organization Name:ANTONIETA A GIMOTEA MD PA
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ANTONIETA
Authorized Official - Middle Name:A
Authorized Official - Last Name:GIMOTEA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:956-585-2822
Mailing Address - Street 1:1022 E GRIFFIN PKWY
Mailing Address - Street 2:SUITE 105
Mailing Address - City:MISSION
Mailing Address - State:TX
Mailing Address - Zip Code:78572-2400
Mailing Address - Country:US
Mailing Address - Phone:956-585-2822
Mailing Address - Fax:956-585-2632
Practice Address - Street 1:1022 E GRIFFIN PKWY
Practice Address - Street 2:SUITE 105
Practice Address - City:MISSION
Practice Address - State:TX
Practice Address - Zip Code:78572-2400
Practice Address - Country:US
Practice Address - Phone:956-585-2822
Practice Address - Fax:956-585-2632
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-15
Last Update Date:2013-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXK4434208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX160806901Medicaid
G81901Medicare UPIN