Healthcare Provider Details

I. General information

NPI: 1639267164
Provider Name (Legal Business Name): TRINITY CLINICAL ASSOCATES PAIN MANAGEMENT
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/10/2006
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4204 GARDENDALE ST. STE 203
SAN ANTONIO TX
78229-3139
US

IV. Provider business mailing address

4204 GARDENDALE ST. STE 203
SAN ANTONIO TX
78229-3139
US

V. Phone/Fax

Practice location:
  • Phone: 210-614-8452
  • Fax: 210-614-8561
Mailing address:
  • Phone: 210-614-8452
  • Fax: 210-614-8561

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number14338
License Number StateTX
# 2
Primary TaxonomyN
Taxonomy Code171100000X
TaxonomyAcupuncturist
License NumberAC00174
License Number StateTX
# 3
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number028861
License Number StateTX

VIII. Authorized Official

Name: MR. JOHN G. DIMLER
Title or Position: DIRECTOR
Credential: L.P.C.
Phone: 210-614-8452