1245677434 NPI number — SAN ANTONIO DIABETES AND ENDOCRINOLOGY CONSULTANTS PLLC

Table of content: (NPI 1245677434)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1245677434 NPI number — SAN ANTONIO DIABETES AND ENDOCRINOLOGY CONSULTANTS PLLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
SAN ANTONIO DIABETES AND ENDOCRINOLOGY CONSULTANTS PLLC
Provider Last Name:
Provider First Name:
Provider Middle Name:
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Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
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Provider Other Middle Name:
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NPI Number Information

NPI Number:
1245677434
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
01/12/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
155 E SONTERRA BLVD STE 105
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SAN ANTONIO
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
78258-3988
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
210-314-8045
Provider Business Mailing Address Fax Number:
210-314-8073

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
155 E SONTERRA BLVD STE 105
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SAN ANTONIO
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
78258-3988
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
210-314-8045
Provider Business Practice Location Address Fax Number:
210-314-8073
Provider Enumeration Date:
05/28/2013

Additional Information

Authorized Official

Authorized Official Last Name:
CRUZ
Authorized Official First Name:
JAIME
Authorized Official Middle Name:
OSCAR
Authorized Official Title or Position:
MEMBER
Authorized Official Telephone Number:
210-314-8045

Provider Taxonomy Codes

  • Taxonomy code: 207RE0101X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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