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8530 Village Dr San Antonio TX 78217-5504 | |
(210) 828-4404 | |
(210) 828-4982 |
Full Name | |
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Speciality | Clinic/center |
Location | 8530 Village Dr, San Antonio, Texas |
Authorized Official Name and Position | Elias Jurado Lorenzana (MEDICAL DIRECTOR) |
Authorized Official Contact | 2108284404 |
Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
Mailing Address | Practice Location Address |
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8530 Village Dr San Antonio TX 78217-5504 Ph: (210) 828-4404 | 8530 Village Dr San Antonio TX 78217-5504 Ph: (210) 828-4404 |
NPI Number | 1154749737 |
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Provider Enumeration Date | 04/01/2014 |
Last Update Date | 04/01/2014 |
Identifier | Type | State | Issuer |
---|---|---|---|
1154749737 | NPI | - | NPPES |
1700867934 | Other | TX | NPI |
00FT10 | Medicaid | TX |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
261Q00000X | Clinic/center | E6481 (Texas) | Primary |
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