Provider Demographics
NPI:1538891585
Name:VALLEJO AVILA, SERGIO ANDRES (MD)
Entity type:Individual
Prefix:
First Name:SERGIO
Middle Name:ANDRES
Last Name:VALLEJO AVILA
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 1:5114 MEDICAL DR APT 1217
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78229-3839
Mailing Address - Country:US
Mailing Address - Phone:305-850-5910
Mailing Address - Fax:
Practice Address - Street 1:4114 MEDICAL DR APT 1217
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78229-5633
Practice Address - Country:US
Practice Address - Phone:305-850-5910
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-06-28
Last Update Date:2022-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program