Basic Information
| Provider Information | |||||||||
| NPI: | 1417116500 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | AZPURUA | ||||||||
| FirstName: | FEDERICO | ||||||||
| MiddleName: | EMILIO | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 3046 | ||||||||
| Address2: | |||||||||
| City: | MALVERN | ||||||||
| State: | PA | ||||||||
| PostalCode: | 193550746 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9566305522 | ||||||||
| FaxNumber: | 9566827730 | ||||||||
| Practice Location | |||||||||
| Address1: | 500 E RIDGE RD STE 300 | ||||||||
| Address2: | |||||||||
| City: | MCALLEN | ||||||||
| State: | TX | ||||||||
| PostalCode: | 785031508 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9566305522 | ||||||||
| FaxNumber: | 9566827730 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/04/2008 | ||||||||
| LastUpdateDate: | 07/21/2022 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | P5258 | TX | N | Allopathic & Osteopathic Physicians | Internal Medicine | 207RC0000X | P5258 | TX | N | Allopathic & Osteopathic Physicians | Internal Medicine | Cardiovascular Disease | 207RI0011X | P5258 | TX | Y | Allopathic & Osteopathic Physicians | Internal Medicine | Interventional Cardiology |
ID Information
| ID | Type | State | Issuer | Description | 8DT948 | 01 | TX | BCBS | OTHER | 3240731-01 | 05 | TX | MEDICAID |