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5414 Fredericksburg Rd Ste 265 San Antonio TX 78229-3641 | |
(210) 256-1539 | |
(210) 549-0039 |
Full Name | |
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Speciality | Family Medicine |
Location | 5414 Fredericksburg Rd Ste 265, San Antonio, Texas |
Authorized Official Name and Position | Nelson Bocanegra (PRACTICE MANAGER) |
Authorized Official Contact | 2102561539 |
Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
Mailing Address | Practice Location Address |
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5414 Fredericksburg Rd Ste 265 San Antonio TX 78229-3641 Ph: (210) 256-1539 | 5414 Fredericksburg Rd Ste 265 San Antonio TX 78229-3641 Ph: (210) 256-1539 |
NPI Number | 1396231320 |
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Provider Enumeration Date | 07/02/2018 |
Last Update Date | 09/25/2019 |
Identifier | Type | State | Issuer |
---|---|---|---|
1396231320 | NPI | - | NPPES |
1972500684 | Other | TX | PPO, HMO AND MARKET-PLACE |
1396231320 | Medicaid | TX | |
1972500684 | Medicaid | TX | |
1396231320 | Other | TX | PPO, HMO AND MARKET PLACE |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
207Q00000X | Family Medicine | (* (Not Available)) | Primary |
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