Provider Demographics
NPI:1902029721
Name:PRIETO, ELIAS MATEO (MD)
Entity Type:Individual
Prefix:DR
First Name:ELIAS
Middle Name:MATEO
Last Name:PRIETO
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 1:730 N MAIN AVE
Mailing Address - Street 2:SUITE 219
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78205-1152
Mailing Address - Country:US
Mailing Address - Phone:210-227-0195
Mailing Address - Fax:210-227-0196
Practice Address - Street 1:730 N MAIN AVE
Practice Address - Street 2:SUITE 219
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78205-1152
Practice Address - Country:US
Practice Address - Phone:210-227-0195
Practice Address - Fax:210-227-0196
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXC7093207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXZ000R57R0-P082X6406Medicaid
TXR57R-82X640Medicare ID - Type Unspecified
TXZ000R57R0-P082X6406Medicaid