| Conviva Care Center | |
|
18414 Us Highway 281 N Ste 104 San Antonio TX 78259 | |
| (210) 495-0222 | |
| (210) 495-5914 |
| Full Name | Conviva Care Center |
|---|---|
| Speciality | Family Medicine |
| Location | 18414 Us Highway 281 N Ste 104, San Antonio, Texas |
| Authorized Official Name and Position | Gemma Rosello (VP) |
| Authorized Official Contact | 3055002000 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Conviva Care Center 6101 Blue Lagoon Dr Ste 400 Miami FL 33126-2051 Ph: (305) 500-2000 | Conviva Care Center 18414 Us Highway 281 N Ste 104 San Antonio TX 78259 Ph: (210) 495-0222 |
| NPI Number | 1972842664 |
|---|---|
| Provider Enumeration Date | 01/31/2013 |
| Last Update Date | 10/19/2020 |
| Medicare PECOS PAC ID | 9436399540 |
|---|---|
| Medicare Enrollment ID | O20130715000288 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1972842664 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | (* (Not Available)) | Primary |
| 208D00000X | General Practice | (* (Not Available)) | Secondary |
| Provider Name | Vivian M.h. Ayoub |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1215971882 PECOS PAC ID: 2264331834 Enrollment ID: I20040102000296 |
| Provider Name | Caroline Hernandez |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1346318052 PECOS PAC ID: 5395732499 Enrollment ID: I20040429001019 |
| Provider Name | Leticia Delgado |
|---|---|
| Provider Type | Practitioner - Physician Assistant |
| Provider Identifiers | NPI Number: 1861473845 PECOS PAC ID: 9234192071 Enrollment ID: I20041111000719 |
| Provider Name | Shannon R Prevette |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1780681510 PECOS PAC ID: 8325948110 Enrollment ID: I20061025000180 |
| Provider Name | Randolph M Gamez |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1215998885 PECOS PAC ID: 3274533526 Enrollment ID: I20070110000305 |
| Provider Name | An Thien Tang |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1841357589 PECOS PAC ID: 4183703341 Enrollment ID: I20080430000174 |
| Provider Name | Clyde C Clybourn |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1043391758 PECOS PAC ID: 1557431251 Enrollment ID: I20080607000023 |
| Provider Name | Maria I Botez |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1346349420 PECOS PAC ID: 4385688993 Enrollment ID: I20090303000676 |
| Provider Name | Sergio A Avalos |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1033146006 PECOS PAC ID: 5799828463 Enrollment ID: I20100203000200 |
| Provider Name | Stephen H Barth |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1700885225 PECOS PAC ID: 5395873996 Enrollment ID: I20100430000702 |
| Provider Name | Adam M Lukasik |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1497806202 PECOS PAC ID: 5092993642 Enrollment ID: I20110629000596 |
| Provider Name | Pavel Valdes |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1851553473 PECOS PAC ID: 9335309079 Enrollment ID: I20120404000496 |
| Provider Name | Crystal M Carbajal |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1366878043 PECOS PAC ID: 2668605841 Enrollment ID: I20140424001351 |
| Provider Name | Marie Dana Ruiz |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1598175200 PECOS PAC ID: 2264658426 Enrollment ID: I20140723002118 |
| Provider Name | Crystal Darlene Chatman-brown |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1851309710 PECOS PAC ID: 6103130125 Enrollment ID: I20150805006857 |
| Provider Name | Yvette Alvarez |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1528328309 PECOS PAC ID: 6305062019 Enrollment ID: I20150925002234 |
| Provider Name | David Medrano |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1972988632 PECOS PAC ID: 2466747878 Enrollment ID: I20160824002403 |
| Provider Name | Margo Lizette Gonzalez-hussey |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1619314879 PECOS PAC ID: 9537303326 Enrollment ID: I20160826000447 |
| Provider Name | Jerry Lee Burris |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1336326214 PECOS PAC ID: 1153552401 Enrollment ID: I20170712000568 |
| Provider Name | Dalailah Reyna De La Rosa |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1962947242 PECOS PAC ID: 9335413517 Enrollment ID: I20170927001447 |
| Provider Name | Rodolfo Cruz |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1922517788 PECOS PAC ID: 8224396528 Enrollment ID: I20171219003004 |
| Provider Name | Aimee Allon Hunt |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1407250681 PECOS PAC ID: 6002187911 Enrollment ID: I20180627002407 |
| Provider Name | Lynn A Van Epps |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1073942660 PECOS PAC ID: 1052548740 Enrollment ID: I20181025000557 |
| Provider Name | Hillary C Engleman |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1740756451 PECOS PAC ID: 1850634239 Enrollment ID: I20190529000467 |
| Provider Name | Danielle R Cavignac |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1023515574 PECOS PAC ID: 2264760800 Enrollment ID: I20190821001418 |
| Provider Name | Juanita Garcia-solis |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1154619005 PECOS PAC ID: 2668759796 Enrollment ID: I20200302001015 |
| Provider Name | Eileen Jill Ramos Muzzillo |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1003343310 PECOS PAC ID: 3870906712 Enrollment ID: I20210113002035 |
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