1952306649 NPI number — CARDIOLOGY OF SAN ANTONIO PA

Table of content: (NPI 1952306649)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1952306649 NPI number — CARDIOLOGY OF SAN ANTONIO PA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CARDIOLOGY OF SAN ANTONIO PA
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
GUILERMO A. REYES, MD
Provider Other Organization Name Type Code:
5
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1952306649
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
05/18/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
8093 ECKHERT RD
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:
78240-2637
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
210-949-1300
Provider Business Mailing Address Fax Number:
210-949-1475

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
8093 ECKHERT RD
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:
78240-2637
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
210-949-1300
Provider Business Practice Location Address Fax Number:
210-949-1475
Provider Enumeration Date:
06/17/2005

Additional Information

Authorized Official

Authorized Official Last Name:
REYES
Authorized Official First Name:
ROBERTO
Authorized Official Middle Name:
ALONSO
Authorized Official Title or Position:
OFFICE ADMINISTRATOR
Authorized Official Telephone Number:
210-949-1300

Provider Taxonomy Codes

  • Taxonomy code: 207RC0000X , with the licence number:  J1563 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 080113601 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".




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