MEDICARE: ISLA PRIMARY CARE PLLC

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	363LF0000X	Family Nurse Practitioner

General Provider Information

NPI Number	:	1861266041
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ISLA PRIMARY CARE PLLC

Provider Business Mailing Address
First Line	:	2209 ELYSIAN TRL
Second Line	:
City	:	SAN ANTONIO
State	:	TX
Zip	:	78253-4112
Country	:	US
Telephone Number	:	210-724-3049
Fax Number	:

Provider Business Practice Location Address
First Line	:	2209 ELYSIAN TRL
Second Line	:
City	:	SAN ANTONIO
State	:	TX
Zip	:	78253-4112
Country	:	US
Telephone Number	:	210-724-3049
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	BERNARDO N ISLA
Credential	:	FNP
Telephone Number	:	210-724-3049

Provider Enumeration Date	:	11/08/2023
Last Update Date	:	11/08/2023

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