Provider Demographics
NPI:1063049104
Name:AVELINO, EMMANUEL LUIS ANDRES (MD)
Entity type:Individual
Prefix:DR
First Name:EMMANUEL LUIS
Middle Name:ANDRES
Last Name:AVELINO
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 1:2900 W DALLAS ST APT 438
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77019-4099
Mailing Address - Country:US
Mailing Address - Phone:810-417-7299
Mailing Address - Fax:
Practice Address - Street 1:6431 FANNIN STREET
Practice Address - Street 2:SUITE MSB 1.134
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77030
Practice Address - Country:US
Practice Address - Phone:713-500-6500
Practice Address - Fax:713-500-6500
Is Sole Proprietor?:No
Enumeration Date:2020-03-26
Last Update Date:2023-12-04
Deactivation Date:2023-10-06
Deactivation Code:
Reactivation Date:2023-11-17
Provider Licenses
StateLicense IDTaxonomies
TXU6679208000000X, 207R00000X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No208000000XAllopathic & Osteopathic PhysiciansPediatrics