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1202 E Sonterra Blvd Suite 301 San Antonio TX 78258-4089 | |
| (210) 828-2311 | |
| (210) 828-6679 |
| Full Name | |
|---|---|
| Speciality | Family Medicine |
| Location | 1202 E Sonterra Blvd, San Antonio, Texas |
| Authorized Official Name and Position | David K Tharakan (PRESIDENT) |
| Authorized Official Contact | 2108282311 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
1202 E Sonterra Blvd Suite 301 San Antonio TX 78258-4089 Ph: (210) 828-2311 | 1202 E Sonterra Blvd Suite 301 San Antonio TX 78258-4089 Ph: (210) 828-2311 |
| NPI Number | 1548484009 |
|---|---|
| Provider Enumeration Date | 04/13/2007 |
| Last Update Date | 12/28/2007 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1548484009 | NPI | - | NPPES |
| 187745801 | Medicaid | TX |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | L0646 (Texas) | Primary |
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