Sergio Andres Vallejo Avila, MD

Primary specialty

Student in an Organized Health Care Education/Training ProgramTaxonomy code 390200000X

Practice address

4114 Medical Dr Apt 1217
San Antonio, TX 78229-5633

Phone

(305) 850-5910

NPI assigned

Jun 28, 2022

Last updated

Jun 28, 2022By the provider in NPPES

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Electronic endpoints 1

Medicare fee-for-service enrollment

Enrolled in OR

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1656374400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1656374400000",
    "number": "1538891585",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5114 MEDICAL DR APT 1217",
            "city": "SAN ANTONIO",
            "state": "TX",
            "postal_code": "782293839",
            "telephone_number": "305-850-5910"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4114 MEDICAL DR APT 1217",
            "city": "SAN ANTONIO",
            "state": "TX",
            "postal_code": "782295633",
            "telephone_number": "305-850-5910"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "VALLEJO AVILA",
        "first_name": "SERGIO",
        "middle_name": "ANDRES",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2022-06-28",
        "last_updated": "2022-06-28",
        "certification_date": "2022-06-28",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "vallejoavila@uthscsa.edu",
            "affiliation": "N",
            "address_1": "5114 Medical Dr Apt 1217",
            "city": "San Antonio",
            "state": "TX",
            "country_code": "US",
            "postal_code": "782293839",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• Jennifer Nicole Valle
• Jessica Marie Valle, PT
• Jose Julian Valle, MD
• Vallecare, L.L.C.
• Kevin Vallecillos, DPT
• Asenet Vallejo, BCBA
• Ellen Vallejo, LPC
• Lillianna Vallejo
• Mari Vallejo, RN, BSN
• Paola G Vallejo

• Student in an Organized Health Care Education/Training Program in San Antonio, TX
• Providers in San Antonio, TX by specialty
• Student in an Organized Health Care Education/Training Program in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 28, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.