Healthcare Provider Details

I. General information

NPI: 1497251698
Provider Name (Legal Business Name): VAZ URGENT CARE CLINIC, PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/05/2018
Last Update Date: 04/05/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1003 N SARAH DEWITT DRIVE
GONZALES TX
78629
US

IV. Provider business mailing address

1003 N SARAH DEWITT DRIVE
GONZALES TX
78629
US

V. Phone/Fax

Practice location:
  • Phone: 830-672-2424
  • Fax:
Mailing address:
  • Phone: 830-672-2424
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QU0200X
TaxonomyUrgent Care Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: GARTH VAZ
Title or Position: PRESIDENT
Credential: MD
Phone: 830-672-2424