Provider Demographics
NPI:1427084763
Name:REQUEIJO, PAULA VERONICA (MD)
Entity type:Individual
Prefix:DR
First Name:PAULA
Middle Name:VERONICA
Last Name:REQUEIJO
Suffix:
Gender:
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:3901A SPICEWOOD SPRINGS RD
Mailing Address - Street 2:SUITE #201
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78759-8723
Mailing Address - Country:US
Mailing Address - Phone:737-226-6700
Mailing Address - Fax:737-226-6777
Practice Address - Street 1:3901A SPICEWOOD SPRINGS RD
Practice Address - Street 2:SUITE #201
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78759-8723
Practice Address - Country:US
Practice Address - Phone:737-226-6700
Practice Address - Fax:737-226-6777
Is Sole Proprietor?:No
Enumeration Date:2006-06-25
Last Update Date:2025-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ71751207R00000X
NV18642207R00000X
CODR.0073799207R00000X
OH35.152420207R00000X
MI4301513383207R00000X
TXL9867207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1694887-01Medicaid
TX169488701Medicaid
TX8C8860Medicare PIN
TXTXB122059Medicare PIN
TXI21486Medicare UPIN
TX169488701Medicaid
I21486Medicare UPIN