Provider Demographics
NPI:1881743839
Name:MAYORGA, DAVID ALVARO (MD)
Entity type:Individual
Prefix:
First Name:DAVID
Middle Name:ALVARO
Last Name:MAYORGA
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 1:3201 SAN CLEMENTE
Mailing Address - Street 2:
Mailing Address - City:MISSION
Mailing Address - State:TX
Mailing Address - Zip Code:78572-7682
Mailing Address - Country:US
Mailing Address - Phone:956-424-3052
Mailing Address - Fax:956-424-3219
Practice Address - Street 1:1022 E GRIFFIN PKWY
Practice Address - Street 2:SUITE 201 B
Practice Address - City:MISSION
Practice Address - State:TX
Practice Address - Zip Code:78572-2400
Practice Address - Country:US
Practice Address - Phone:956-424-3052
Practice Address - Fax:956-424-3219
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-09
Last Update Date:2020-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXL8428207RI0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0200XAllopathic & Osteopathic PhysiciansInternal MedicineInfectious Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX8V4021OtherBLUE CROSS
TX162581602Medicaid
TX8V4021OtherBLUE CROSS
TX162581602Medicaid
TX8G0857Medicare PIN