Unknown Individual – Pediatrics Physician, NPI 1790775435

Unknown Individual is a healthcare provider. based in San angelo, Texas. specializing in Pediatrics Physician. They hold a License No. G3657 (TX). The NPI Number for Unknown Individual is 1790775435

Main info

Organization
Inactive
Name
Unknown Individual
NPI
1790775435
Phone
(325) 658-1511
Address
PO BOX 22000
Deactivation Date
16 September 2021
Data current as of
19 May 2026

Profile Insights

NPPES metrics only — not quality of care.

Methodology
Experience14
Completeness75
Years active:0State licenses:1Digital endpointsOther names

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Provider Addresses for Unknown Individual

  • PO BOX 22000

    SAN ANGELO, TX 769027200

    Phone: (325) 658-1511

    Type: Mailing

  • 1801, North Bedell Avenue, Del Rio, Val Verde County, Texas, 78840, United States

    DEL RIO, TX 788408001

    Phone: (830) 768-9200

    Type: Location

NPPES updates history

No NPPES updates recorded for this provider.

Prescription Activity

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Open Payments (CMS)

No Open Payments data available for this provider.

This can happen when there are no reportable CMS Open Payments records.

Medicare Enrollment & Revalidation

Source: CMS public data · Not endorsed by CMS ·

Educational use only—not medical, billing, or legal advice.

No Medicare enrollment or revalidation data available for this provider in our database.

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Medicare Utilization (FFS)

Source: CMS public data · Not endorsed by CMS · Beneficiary counts under 11 are suppressed in source data ·

Educational use only—not medical, billing, or legal advice.

No Medicare fee-for-service utilization data available for this provider in our database.

Insurance plans in this area (ZIP 76902)

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Reviews

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Frequently asked questions

Does Unknown Individual share an NPI with anyone else?
NPI numbers are unique to each provider or organization — Unknown Individual uses 1790775435.
Is Unknown Individual's NPI deactivated?
The extract indicates Unknown Individual is not in an active NPI state.
What taxonomy line describes Unknown Individual?
For research purposes, treat Unknown Individual as Pediatrics Physician in this dataset. Clinical services aligned with this taxonomy classification.
Does Unknown Individual list a practice location?
Patients near San Angelo, Texas may find Unknown Individual in results; validate coverage separately.
Why does Unknown Individual have multiple addresses?
2 practice locations appear in the available data. Multiple addresses are common for hospital privileges, telehealth, or multi-site groups.

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