Anselmo Boaventura
Individual provider Active NPI Driver · North Richland Hills, TX
NPI 1689255010 · NPPES record last updated Apr 17, 2021
Key facts
- NPI
- 1689255010
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Driver 172A00000X
- License
- 40917713 (TX)
- Practice address
- 6100 Browning Dr Apt 7203
North Richland Hills, TX 76180-9066 - Phone
- (516) 360-8323
- NPI assigned
- Apr 17, 2021
- Sex
- Male
- Sole proprietor
- Yes
Organizations & group practices 1
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 40917713 | TX | MD | Driver |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Tebotech | Current |
Accepting new patients |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Driver | 172A00000X | 40917713 | TX | Yes |
Addresses
Primary practice location
6100 Browning Dr Apt 7203
North Richland Hills, TX 76180-9066
Mailing address
6100 Browning Dr Apt 7203
North Richland Hills, TX 76180-9066
Phone (516) 360-8323
Other providers in North Richland Hills, TX
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Apr 17, 2021. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.