Provider Demographics
NPI:1881162832
Name:ARTEAGA, JOSE JAVIER (PA-C)
Entity type:Individual
Prefix:
First Name:JOSE
Middle Name:JAVIER
Last Name:ARTEAGA
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6801 S IH 35 STE 1-E
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78744-4824
Mailing Address - Country:US
Mailing Address - Phone:512-978-9960
Mailing Address - Fax:
Practice Address - Street 1:6801 S IH 35 STE 1-E
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78744-4824
Practice Address - Country:US
Practice Address - Phone:512-978-9960
Practice Address - Fax:512-776-0470
Is Sole Proprietor?:No
Enumeration Date:2018-11-07
Last Update Date:2019-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPA56115363A00000X
TXPA12287363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant