MEDICARE: DR. RACHEL GRINNAN DO

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	390200000X	Student in an Organized Health Care Education/Training Program
2	2086S0129X	Vascular Surgery Physician	U5113	TX

General Provider Information

NPI Number	:	1215383815
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. RACHEL GRINNAN DO

Provider Business Mailing Address
First Line	:	2210 CASTELLO WAY
Second Line	:
City	:	SAN ANTONIO
State	:	TX
Zip	:	78259-2202
Country	:	US
Telephone Number	:	434-258-9404
Fax Number	:

Provider Business Practice Location Address
First Line	:	1200 BROOKLYN AVE STE 201
Second Line	:
City	:	SAN ANTONIO
State	:	TX
Zip	:	78212-4802
Country	:	US
Telephone Number	:	210-281-9800
Fax Number	:	210-281-1001

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/12/2016
Last Update Date	:	09/03/2024

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