Healthcare Provider Details

I. General information

NPI: 1336998855
Provider Name (Legal Business Name): EKATERINA ALDONZA TANGOG DO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/16/2024
Last Update Date: 10/23/2025
Certification Date: 10/23/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

BROOKE ARMY MEDICAL CENTER, MCHE-MDX INTERNAL MEDICINE RESIDENCY, 3551 ROGER BROOKE DR.
JBSA-FORT SAM HOUSTON TX
78234-4504
US

IV. Provider business mailing address

3551 ROGER BROOKE DR
JBSA FT SAM HOUSTON TX
78234-4504
US

V. Phone/Fax

Practice location:
  • Phone: 210-292-3410
  • Fax: 210-292-7868
Mailing address:
  • Phone: 210-292-3410
  • Fax: 210-292-7868

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number3092
License Number StateNE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: