Provider Demographics
NPI:1912046509
Name:FRONTERA PEDIATRICS PA
Entity Type:Organization
Organization Name:FRONTERA PEDIATRICS PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:CESAR
Authorized Official - Middle Name:H
Authorized Official - Last Name:FAZ
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:830-778-5439
Mailing Address - Street 1:109 W MARTIN ST
Mailing Address - Street 2:
Mailing Address - City:DEL RIO
Mailing Address - State:TX
Mailing Address - Zip Code:78840-5501
Mailing Address - Country:US
Mailing Address - Phone:830-778-5439
Mailing Address - Fax:830-778-5400
Practice Address - Street 1:109 W MARTIN ST
Practice Address - Street 2:
Practice Address - City:DEL RIO
Practice Address - State:TX
Practice Address - Zip Code:78840-5501
Practice Address - Country:US
Practice Address - Phone:830-778-5439
Practice Address - Fax:830-778-5400
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-06
Last Update Date:2009-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX166733902Medicaid
TX166733901Medicaid
TX8P6044OtherBCBS